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Individual

MARY BENSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3737 40TH AVE NW, ROCHESTER, MN 55901-1772
(507) 288-6978
Mailing address
723 6TH ST SW, ROCHESTER, MN 55902-2971
(320) 260-0873

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP6216
MN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1174985030
NPI I
MN
Enumeration date
03/22/2016
Last updated
10/22/2020
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