Provider Demographics
NPI:1689805822
Name:REECE, BENJAMIN KENDALL (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:KENDALL
Last Name:REECE
Suffix:
Gender:M
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 1:4212 N PERSHING AVE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6952
Mailing Address - Country:US
Mailing Address - Phone:209-957-3900
Mailing Address - Fax:
Practice Address - Street 1:4212 N PERSHING AVE
Practice Address - Street 2:SUITE A1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6952
Practice Address - Country:US
Practice Address - Phone:209-957-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist