Provider Demographics
NPI:1164674701
Name:BENIVEGNA, SHARON ANN (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:BENIVEGNA
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:ANN
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-CCC-A
Mailing Address - Street 1:8600 N. STATE RT 91
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7832
Mailing Address - Country:US
Mailing Address - Phone:309-691-6616
Mailing Address - Fax:309-691-2943
Practice Address - Street 1:8600 N. STATE RT 91
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7832
Practice Address - Country:US
Practice Address - Phone:309-691-6616
Practice Address - Fax:309-691-2943
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000778231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist