Provider Demographics
NPI:1336278589
Name:BENGE, MARY RILEY (SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RILEY
Last Name:BENGE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CECELIA
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:7401 W BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5362
Mailing Address - Country:US
Mailing Address - Phone:623-979-5231
Mailing Address - Fax:
Practice Address - Street 1:7401 W BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5362
Practice Address - Country:US
Practice Address - Phone:623-979-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist