Benjamin Defazio
Speech-Language Pathologist, in Nutter Fort, WV. Individual provider (NPI-1).
NPI number1124429337
StatusActive
Last updated in NPPESSep 7, 2014
Details
- NPI
- 1124429337
- Entity type
- Individual (NPI-1)
- Name
- Benjamin Defazio
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 7, 2014
- Last updated
- Sep 7, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 235Z00000X | Speech-Language Pathologist, | – | – | Yes |
Practice location
304 Pennsylvania AveNutter Fort, WV 26301-4520
Phone 304-933-3073
Mailing address
304 Pennsylvania AveNutter Fort, WV 26301-4520
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