Provider Demographics
NPI:1679132542
Name:BENSON, VANESSA (MA CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 ANTOINETTE CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3626
Mailing Address - Country:US
Mailing Address - Phone:814-397-5383
Mailing Address - Fax:
Practice Address - Street 1:226 E 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1002
Practice Address - Country:US
Practice Address - Phone:814-454-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004705L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist