Provider Demographics
NPI:1467610428
Name:BENSON, DEBORAH LUETKENHOELTER (MA/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LUETKENHOELTER
Last Name:BENSON
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:JAY
Other - Last Name:LUETKENHOELTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/CCC-SLP
Mailing Address - Street 1:1443 ELAINE WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2890
Mailing Address - Country:US
Mailing Address - Phone:541-219-6529
Mailing Address - Fax:
Practice Address - Street 1:675 N 5TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9659
Practice Address - Country:US
Practice Address - Phone:541-227-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00724153OtherAMERICAN SPEECH AND HEARING ASSOCIATION
OR10404OtherSTATE OF OREGON PROFESSIONAL LICENSE