Provider Demographics
NPI:1558485318
Name:BROOKS, BENCITA BUGARIN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BENCITA
Middle Name:BUGARIN
Last Name:BROOKS
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 1:6696 OLD 421 S
Mailing Address - Street 2:DEEP GAP
Mailing Address - City:DEEP GAP
Mailing Address - State:NC
Mailing Address - Zip Code:28618-8903
Mailing Address - Country:US
Mailing Address - Phone:828-773-0233
Mailing Address - Fax:
Practice Address - Street 1:2359 HIGHWAY 105
Practice Address - Street 2:BOONE
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7814
Practice Address - Country:US
Practice Address - Phone:828-265-5391
Practice Address - Fax:828-265-5394
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60203OtherBLUE CROSS BLUE SHIELD