Provider Demographics
NPI:1073526562
Name:BENJAMIN, KRISTIN ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ANN
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2922
Mailing Address - Country:US
Mailing Address - Phone:401-465-1182
Mailing Address - Fax:
Practice Address - Street 1:72 SPRING ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2922
Practice Address - Country:US
Practice Address - Phone:401-465-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist