Provider Demographics
NPI:1972960540
Name:BENSON, OLIVIA (SLP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 BROADBAND DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5136
Mailing Address - Country:US
Mailing Address - Phone:443-776-0271
Mailing Address - Fax:
Practice Address - Street 1:8411 BROADBAND DR
Practice Address - Street 2:SUITE D
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5136
Practice Address - Country:US
Practice Address - Phone:443-776-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist