Individual
MADDISON NICOLE BENGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1434 HAWN AVE, SHREVEPORT, LA 71107-6508
(318) 675-0224
Mailing address
6304 WILLOWOOD PL, SHREVEPORT, LA 71107-8113
(318) 294-4456
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/10/2020
Last updated
05/20/2021
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