Provider Demographics
NPI:1275808271
Name:BENZING, SHELLEY (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BENZING
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 1:7430 CROWN BUTTE RD
Mailing Address - Street 2:
Mailing Address - City:LLOYD
Mailing Address - State:MT
Mailing Address - Zip Code:59535-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2621 15TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5201
Practice Address - Country:US
Practice Address - Phone:406-455-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSP969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist