Provider Demographics
NPI:1972016665
Name:BENEDICT, KATHLEEN WHALEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:WHALEN
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 SAN DOMINICO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-4200
Mailing Address - Country:US
Mailing Address - Phone:805-704-0676
Mailing Address - Fax:
Practice Address - Street 1:2569 SAN DOMINICO AVE
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-4200
Practice Address - Country:US
Practice Address - Phone:805-704-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist