Individual
MR. JEFFREY WALTER BENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
1456 PARK AVE W, MANSFIELD, OH 44906-2700
(419) 529-4602
Mailing address
1189 TOWNSHIP ROAD 346, NOVA, OH 44859-9746
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I9160
OH
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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