Provider Demographics
NPI:1437785235
Name:BENSON, BROOKLYN N (SLP)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:N
Last Name:BENSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10122 E OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2362
Mailing Address - Country:US
Mailing Address - Phone:480-740-9536
Mailing Address - Fax:
Practice Address - Street 1:2450 E GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5116
Practice Address - Country:US
Practice Address - Phone:480-506-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA1119992355S0801X
AZTSLP11199235Z00000X
AZSLP11199235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant