Individual
MS. LISA NICOLE BENGTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, ATC, LAT
Contact information
Practice address
610 W 4TH ST, STORM LAKE, IA 50588-1713
(712) 749-2021
(712) 749-1460
Mailing address
17 SAINT ANDREWS DR, STORM LAKE, IA 50588-7800
(712) 299-1134
(712) 749-1460
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
000787
IA
Other
Enumeration date
03/31/2014
Last updated
03/31/2014
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