Provider Demographics
NPI:1548400096
Name:BENENATI, KATIE LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYNN
Last Name:BENENATI
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Mailing Address - Street 1:1921 PRATHER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3546
Mailing Address - Country:US
Mailing Address - Phone:314-645-1202
Mailing Address - Fax:314-645-2618
Practice Address - Street 1:1921 PRATHER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3546
Practice Address - Country:US
Practice Address - Phone:314-645-1202
Practice Address - Fax:314-645-2618
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2008021559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist