Individual
DR. JEAN A BENACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1701 S PROSPECT AVE, SUITE 205, CHAMPAIGN, IL 61820-7050
(217) 352-9206
(217) 352-9186
Mailing address
1701 S PROSPECT AVE, SUITE 205, CHAMPAIGN, IL 61820-7050
(217) 352-9206
(217) 352-9186
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071003677
IL
Other
Enumeration date
08/30/2006
Last updated
12/21/2010
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