Individual
BLAKE BENAVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2407 W LOUISIANA AVE STE 110, MIDLAND, TX 79701-5826
(143) 257-0440
Mailing address
2407 W LOUISIANA AVE STE 110, MIDLAND, TX 79701-5826
(143) 257-0440
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117394
TSHA
TX
Enumeration date
08/19/2021
Last updated
08/19/2021
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