Provider Demographics
NPI:1851537377
Name:BENZ, ANDREA C (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:C
Last Name:BENZ
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 1:8199 E SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-2101
Mailing Address - Country:US
Mailing Address - Phone:315-637-7466
Mailing Address - Fax:
Practice Address - Street 1:8199 E SENECA TPKE
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-2101
Practice Address - Country:US
Practice Address - Phone:315-637-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13086-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist