Provider Demographics
NPI:1588919955
Name:BENCIN, MARYANN (MA CCC/A, FAAA)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:BENCIN
Suffix:
Gender:F
Credentials:MA CCC/A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MENTOR AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1459
Mailing Address - Country:US
Mailing Address - Phone:440-357-4327
Mailing Address - Fax:440-357-4328
Practice Address - Street 1:1701 MENTOR AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1459
Practice Address - Country:US
Practice Address - Phone:440-357-4327
Practice Address - Fax:440-357-4328
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00593231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H324551Medicare PIN