Provider Demographics
NPI:1902355464
Name:BENITEZ, MINDY LEE (MS CCC/ SLP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:LEE
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:MS CCC/ SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 GRAND OAKS CT
Mailing Address - Street 2:
Mailing Address - City:ALVORD
Mailing Address - State:TX
Mailing Address - Zip Code:76225-6020
Mailing Address - Country:US
Mailing Address - Phone:940-577-4550
Mailing Address - Fax:940-427-2315
Practice Address - Street 1:2804 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2234
Practice Address - Country:US
Practice Address - Phone:817-723-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist