Provider Demographics
NPI:1134714280
Name:HUNTINGTON, BENITA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:HUNTINGTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E GOODHEART AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2809
Mailing Address - Country:US
Mailing Address - Phone:407-687-4673
Mailing Address - Fax:
Practice Address - Street 1:129 E GOODHEART AVE
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2809
Practice Address - Country:US
Practice Address - Phone:407-687-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist