Provider Demographics
NPI:1003550799
Name:BENJAMINSON, KELSEY RAE (SLPA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAE
Last Name:BENJAMINSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10222 E KEATS AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-1264
Mailing Address - Country:US
Mailing Address - Phone:480-203-0811
Mailing Address - Fax:
Practice Address - Street 1:20033 N 19TH AVE STE 121
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4251
Practice Address - Country:US
Practice Address - Phone:602-875-5616
Practice Address - Fax:623-227-2030
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA13745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist