Provider Demographics
NPI:1659788289
Name:BENJAMIN, JOANNA EDNA (MA CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:EDNA
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24697 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3133
Mailing Address - Country:US
Mailing Address - Phone:586-464-7474
Mailing Address - Fax:
Practice Address - Street 1:44738 MORLEY DRIVE
Practice Address - Street 2:THE CENTER FOR THERAPEUTIC LEARNING AND COMMUNICATION
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:586-421-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist