Provider Demographics
NPI:1588819759
Name:BENOIT, JACLYNNE SUZANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JACLYNNE
Middle Name:SUZANNE
Last Name:BENOIT
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 1:20 WASHINGTON ST
Mailing Address - Street 2:UNIT 3-3
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1016
Mailing Address - Country:US
Mailing Address - Phone:774-406-0799
Mailing Address - Fax:
Practice Address - Street 1:130 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2803
Practice Address - Country:US
Practice Address - Phone:508-941-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist