Individual
DIANA MARIE BENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
248 MACE RD, MEDFORD, OR 97501-1280
(541) 727-7669
Mailing address
3126 STATE ST STE 100, MEDFORD, OR 97504-8665
(458) 225-9358
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
25-QMHA-R-6846
OR
Other
Enumeration date
05/07/2025
Last updated
05/07/2025
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