Individual
MR. BENJAMEN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
PO BOX 913, POWELL, WY 82435-0913
(307) 202-0506
Mailing address
PO BOX 913, POWELL, WY 82435-0913
(307) 202-0506
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116443100
—
WY
Enumeration date
01/19/2007
Last updated
04/07/2025
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