Provider Demographics
NPI:1568942936
Name:BENITEZ, ROXANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ROXANN
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E FORDYCE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-5819
Mailing Address - Country:US
Mailing Address - Phone:956-998-8628
Mailing Address - Fax:
Practice Address - Street 1:3130 S BRAHMA BLVD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7257
Practice Address - Country:US
Practice Address - Phone:361-592-8700
Practice Address - Fax:361-592-3030
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist