Provider Demographics
NPI:1861929820
Name:BENOIT, SUSAN BUCQUET (MS, MED)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BUCQUET
Last Name:BENOIT
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 ANVICK RD
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6703
Mailing Address - Country:US
Mailing Address - Phone:707-267-6540
Mailing Address - Fax:707-822-7542
Practice Address - Street 1:1302 ANVICK RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6703
Practice Address - Country:US
Practice Address - Phone:707-267-6540
Practice Address - Fax:707-822-7542
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist