Provider Demographics
NPI:1881010601
Name:BENSON, MELODY EISENBACH (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:EISENBACH
Last Name:BENSON
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 TOPAZ DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4511
Mailing Address - Country:US
Mailing Address - Phone:972-821-2866
Mailing Address - Fax:
Practice Address - Street 1:2004 TOPAZ DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4511
Practice Address - Country:US
Practice Address - Phone:972-821-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist