Provider Demographics
NPI:1528133378
Name:BENOIT, KATHERINE CROSS (CCC SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CROSS
Last Name:BENOIT
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 POPLAR HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5522
Mailing Address - Country:US
Mailing Address - Phone:757-776-3088
Mailing Address - Fax:757-612-4499
Practice Address - Street 1:3800 POPLAR HILL RD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5522
Practice Address - Country:US
Practice Address - Phone:757-776-3088
Practice Address - Fax:757-612-4499
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8458235Z00000X
VA2202009464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889787500Medicaid