Individual
JERREN BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1049 E NEWELL ST, WHITE CLOUD, MI 49349-8795
(231) 689-7330
Mailing address
1932 HARRISON AVE, MUSKEGON, MI 49441-1543
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801102238
MI
Other
Enumeration date
08/16/2017
Last updated
10/24/2018
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