Provider Demographics
NPI:1457742819
Name:PATRICK, BENITA C (MA,SLP)
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:C
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 THIMBLE SHOALS BLVD
Mailing Address - Street 2:STE 4-C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4217
Mailing Address - Country:US
Mailing Address - Phone:757-873-8732
Mailing Address - Fax:757-873-8780
Practice Address - Street 1:729 THIMBLE SHOALS BLVD
Practice Address - Street 2:STE 4-C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4217
Practice Address - Country:US
Practice Address - Phone:757-873-8732
Practice Address - Fax:757-873-8780
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist