Provider Demographics
NPI:1295037125
Name:BENJAMIN, JESSICA PIERRE
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:PIERRE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3599 SOUTHERN CROSS LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9005
Mailing Address - Country:US
Mailing Address - Phone:321-437-7159
Mailing Address - Fax:
Practice Address - Street 1:7726 WINEGARD RD FL 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7147
Practice Address - Country:US
Practice Address - Phone:321-437-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist