Individual
SHANIA LYNNE BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1414 S 4TH AVE, KELSO, WA 98626-2019
(360) 827-4045
Mailing address
PO BOX 1324, TOLEDO, WA 98591-1324
(360) 827-4045
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
WA
106E00000X
Assistant Behavior Analyst
NONE
WA
106E00000X
Assistant Behavior Analyst
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1234
NONO
—
Enumeration date
11/19/2018
Last updated
06/11/2019
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