Provider Demographics
NPI:1265588891
Name:GARCIA-BENAVIDES, IRENE (SLP)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:GARCIA-BENAVIDES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:EASTERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:5052 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9247
Mailing Address - Country:US
Mailing Address - Phone:956-517-9361
Mailing Address - Fax:956-572-9737
Practice Address - Street 1:5052 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9247
Practice Address - Country:US
Practice Address - Phone:956-517-9361
Practice Address - Fax:956-517-9361
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-3421OtherKENTUCKY BOARD OF SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY
TX24754OtherLICENSE