Provider Demographics
NPI:1508646407
Name:BENTON, KATHRYN (HIS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BENTON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6081
Mailing Address - Country:US
Mailing Address - Phone:214-850-4820
Mailing Address - Fax:
Practice Address - Street 1:1220 N TOWN EAST BLVD STE 214
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4682
Practice Address - Country:US
Practice Address - Phone:972-270-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80991237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist