Provider Demographics
NPI:1356892111
Name:CABRERA-BENSON, GINA LEE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LEE
Last Name:CABRERA-BENSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ST GABRIEL WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5538
Mailing Address - Country:US
Mailing Address - Phone:678-548-6882
Mailing Address - Fax:
Practice Address - Street 1:195 ST GABRIEL WAY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-5538
Practice Address - Country:US
Practice Address - Phone:678-548-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist