Individual
AMI E WALLACE-BENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
3331 STANLEY AVE STE A, DAYTON, OH 45404-2022
(937) 203-0975
Mailing address
PO BOX 549, DAYTON, OH 45404-0549
(937) 203-0975
(855) 595-2759
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I.1600177
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0183087
—
OH
Enumeration date
08/11/2016
Last updated
07/15/2022
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