Provider Demographics
NPI:1619534294
Name:BENONE, CARESSA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARESSA
Middle Name:
Last Name:BENONE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 GARRISONVILLE RD STE 2015
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3655
Mailing Address - Country:US
Mailing Address - Phone:571-228-1708
Mailing Address - Fax:
Practice Address - Street 1:1229 GARRISONVILLE RD STE 2015
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3655
Practice Address - Country:US
Practice Address - Phone:571-228-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist