Provider Demographics
NPI:1609866565
Name:BENSON, SUSAN ELIZABETH (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N STONEWALL AVE
Mailing Address - Street 2:JOHN W KEYS SPEECH AND HEARING CENTER
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4649
Mailing Address - Country:US
Mailing Address - Phone:405-271-4214
Mailing Address - Fax:405-271-3360
Practice Address - Street 1:1200 N STONEWALL AVE
Practice Address - Street 2:JOHN W KEYS SPEECH AND HEARING CENTER
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1215
Practice Address - Country:US
Practice Address - Phone:405-271-4214
Practice Address - Fax:405-271-3360
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100661870AMedicaid