Individual
JOHN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., LP
Contact information
Practice address
8451 POINT DOUGLAS ROAD E, COTTAGE GROVE, MN 55016
(651) 458-4116
(651) 458-5632
Mailing address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 777-5222
(651) 251-5111
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2790
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106225
UC
MN
01
—
17574
HP
MN
01
—
252287
CP
MN
01
—
570033
P1
MN
01
—
57129BE
BCBS
MN
01
—
62-20082
UBH
MN
Enumeration date
07/17/2006
Last updated
07/08/2007
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