Provider Demographics
NPI:1629575154
Name:BENITEZ, VICKMARY (SLPA)
Entity Type:Individual
Prefix:MISS
First Name:VICKMARY
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 SW 72ND ST STE 261
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5457
Mailing Address - Country:US
Mailing Address - Phone:305-271-7343
Mailing Address - Fax:
Practice Address - Street 1:9425 SW 72ND ST STE 261
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5457
Practice Address - Country:US
Practice Address - Phone:305-271-7343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI34752355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant