Provider Demographics
NPI:1518204205
Name:BENSON, MEAGAN NICOLE (SLP)
Entity Type:Individual
Prefix:MS
First Name:MEAGAN
Middle Name:NICOLE
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 1:1201 W 4TH PL
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5835
Mailing Address - Country:US
Mailing Address - Phone:479-968-2650
Mailing Address - Fax:
Practice Address - Street 1:1201 W 4TH PL
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5835
Practice Address - Country:US
Practice Address - Phone:479-968-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist