Provider Demographics
NPI:1902335722
Name:BENSON, MARENDA KATE (M ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARENDA
Middle Name:KATE
Last Name:BENSON
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 HICKORY FLAT HWY STE 108
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:770-345-2804
Mailing Address - Fax:
Practice Address - Street 1:4280 HICKORY FLAT HWY STE 108
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-6634
Practice Address - Country:US
Practice Address - Phone:770-345-2804
Practice Address - Fax:770-345-2804
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist