Nicole Benham
Individual provider Active NPI Speech-Language Pathologist · Birmingham, MI
NPI 1578067633 · NPPES record last updated Sep 3, 2026
Key facts
- NPI
- 1578067633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 7101006223 (MI)
- Practice address
- 1300 Derby Rd
Birmingham, MI 48009-5811 - Phone
- (248) 203-5076
- NPI assigned
- Mar 22, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7101006223 | MI | Yes |
Addresses
Primary practice location
1300 Derby Rd
Birmingham, MI 48009-5811
Mailing address
500 Kentucky Dr
Rochester Hills, MI 48307-3731
Phone (734) 812-9964
Other names
- Nicole Favaro
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All providers in Birmingham, MI · Speech-Language Pathologist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.