Provider Demographics
NPI:1659042851
Name:BENTON, MISTY MICHELLE (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:MICHELLE
Last Name:BENTON
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 1:190 OLIVIAS CT
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-3669
Mailing Address - Country:US
Mailing Address - Phone:325-725-0980
Mailing Address - Fax:
Practice Address - Street 1:2052 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7832
Practice Address - Country:US
Practice Address - Phone:325-437-8232
Practice Address - Fax:325-672-1376
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist