Provider Demographics
NPI:1396027124
Name:BENNER, KATRINA WEAVER (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:WEAVER
Last Name:BENNER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8528 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471-9637
Mailing Address - Country:US
Mailing Address - Phone:585-229-5171
Mailing Address - Fax:
Practice Address - Street 1:8528 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONEOYE
Practice Address - State:NY
Practice Address - Zip Code:14471-9637
Practice Address - Country:US
Practice Address - Phone:585-229-5171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist