Provider Demographics
NPI:1902004369
Name:BENJAMIN, MEAGHAN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEAGHAN
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:2114 W SHAKESPEARE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3316
Mailing Address - Country:US
Mailing Address - Phone:773-504-7119
Mailing Address - Fax:
Practice Address - Street 1:2114 W SHAKESPEARE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3316
Practice Address - Country:US
Practice Address - Phone:773-504-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist