Individual
BENJAMIN DEFAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
304 PENNSYLVANIA AVE, NUTTER FORT, WV 26301-4520
(304) 933-3073
Mailing address
304 PENNSYLVANIA AVE, NUTTER FORT, WV 26301-4520
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
09/07/2014
Last updated
09/07/2014
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