Individual
MR. BENJAMIN P LONGSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA-CCC/SLP
Contact information
Practice address
1051 DIAMOND ST, SAN DIEGO, CA 92109-2607
(619) 455-6377
Mailing address
5348 LEEWARD LN, NEW PORT RICHEY, FL 34652-3056
(804) 543-6735
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
002420
IA
235Z00000X
Speech-Language Pathologist
Primary
22-3-0
CA
Other
Enumeration date
01/31/2014
Last updated
05/30/2025
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