Provider Demographics
NPI:1922351907
Name:IE PLLC
Entity Type:Organization
Organization Name:IE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BENEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:405-606-5768
Mailing Address - Street 1:1909 VICTORIA PL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3865
Mailing Address - Country:US
Mailing Address - Phone:405-606-5768
Mailing Address - Fax:
Practice Address - Street 1:1909 VICTORIA PL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3865
Practice Address - Country:US
Practice Address - Phone:405-606-5768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty