Provider Demographics
NPI:1154461440
Name:BENYO, MARY JO (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:BENYO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 MAIN ST SW
Mailing Address - Street 2:SUITE #140
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9697
Mailing Address - Country:US
Mailing Address - Phone:616-538-8220
Mailing Address - Fax:616-538-8991
Practice Address - Street 1:2225 MAIN ST SW
Practice Address - Street 2:SUITE #140
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9697
Practice Address - Country:US
Practice Address - Phone:616-538-8220
Practice Address - Fax:616-538-8991
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000333237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter