Provider Demographics
NPI:1891993663
Name:BENSON, KIM A (MA CCC-A)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:A
Last Name:BENSON
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STROUD BUILDING RT. 611 SUITE 100C
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360
Mailing Address - Country:US
Mailing Address - Phone:570-421-6112
Mailing Address - Fax:570-421-7066
Practice Address - Street 1:100C STROUD BUILDING RT. 611
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-9064
Practice Address - Country:US
Practice Address - Phone:570-421-6112
Practice Address - Fax:570-421-7066
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT001039L231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7263015OtherAETNA TRADITIONAL NJ & PA
PA814334OtherFIRST PRIORITY
PA2736797OtherAETNA HMO PA
PABE1375023OtherBLUE CROSS BLUE SHEILD
PA4899809OtherGHI
PA98857OtherLOCAL 825
PA1007412000003Medicaid
PA3531596OtherAETNA HMO NJ
PABE1375023OtherBLUE CROSS BLUE SHEILD