Provider Demographics
NPI:1942972708
Name:HAYES, BENJAMIN LAWRENCE (AZ HIS #4659)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LAWRENCE
Last Name:HAYES
Suffix:
Gender:M
Credentials:AZ HIS #4659
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3936
Mailing Address - Country:US
Mailing Address - Phone:928-219-6926
Mailing Address - Fax:
Practice Address - Street 1:1370 RAMAR RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7117
Practice Address - Country:US
Practice Address - Phone:928-763-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4659237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty