Provider Demographics
NPI:1699445502
Name:BENISCH, CLAIRE E (CF-SLP)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:E
Last Name:BENISCH
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 48TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-9213
Mailing Address - Country:US
Mailing Address - Phone:309-558-0145
Mailing Address - Fax:
Practice Address - Street 1:4450 48TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-9213
Practice Address - Country:US
Practice Address - Phone:309-558-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist