Provider Demographics
NPI:1669845228
Name:BENZIE, KORTNEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:BENZIE
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 1:8001 33RD AVE S UNIT D455
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4638
Mailing Address - Country:US
Mailing Address - Phone:906-869-4713
Mailing Address - Fax:
Practice Address - Street 1:2925 BUCKLEY WAY
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-2018
Practice Address - Country:US
Practice Address - Phone:654-455-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.003484235Z00000X
MN9921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist