Individual
STACY BENVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12635 S 35TH PL, PHOENIX, AZ 85044-3519
(480) 219-8719
(480) 219-8719
Mailing address
12635 S 35TH PL, PHOENIX, AZ 85044-3519
(480) 219-8719
(480) 219-8719
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP0400
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
345018
—
AZ
01
—
AZ0140920
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
02/27/2007
Last updated
04/06/2012
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