Octavia Bentum

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

License

43535 Issued in TX

Practice address

12225 Greenville Ave # 600
Dallas, TX 75243-9362

Phone

(888) 265-1068

NPI assigned

Mar 21, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1104528199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12225 GREENVILLE AVE # 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752439362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12225 GREENVILLE AVE # 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752439362",
            "telephone_number": "888-265-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENTUM",
        "first_name": "OCTAVIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-21",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "7772",
            "primary": false
        },
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "TX",
            "license": "43535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelley Black Benton, PH.D.
• Shonda Benton, FNP-C
• Susan D. Benton, MD
• Bentree Pain Procedure Center
• Chris Bentsen, CRNA
• Benzel C Macmaster MD PA
• Maria Del Pilar Berastain
• Rafic Fouad Berbarie, M.D.
• Courtney Johnson Berberich
• Matthew Berchuck, M.D.

• Speech-Language Assistant in Dallas, TX
• Providers in Dallas, TX by specialty
• Speech-Language Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.