Active NPI
Stacy Benvin
- Speech-Language Pathologist
- Phoenix, AZ
National Provider Identifier
1275660524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP0400
- Practice address
- 12635 S 35TH PL
Phoenix, AZ 85044-3519 - Phone
- (480) 219-8719
- Fax
- (480) 219-8719
- NPI assigned
- Feb 27, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP0400 | AZ | Primary |
Addresses
Primary practice location
12635 S 35TH PL
Phoenix, AZ 85044-3519
Mailing address
12635 S 35TH PL
Phoenix, AZ 85044-3519
Phone (480) 219-8719
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AZ0140920 | Other | AZ | BLUE CROSS BLUE SHIELD |
| 345018 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP0400 | AZ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333670400000",
"number": "1275660524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12635 S 35TH PL",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850443519",
"telephone_number": "480-219-8719",
"fax_number": "480-219-8719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12635 S 35TH PL",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850443519",
"telephone_number": "480-219-8719",
"fax_number": "480-219-8719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENVIN",
"first_name": "STACY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-27",
"last_updated": "2012-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "SLP0400",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "AZ0140920",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "345018",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.