Individual
MRS. CODI JO BENOLOGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
1115 WESTPORT DR STE D2, MANHATTAN, KS 66502-2880
(785) 560-3101
(785) 527-8317
Mailing address
1329 18TH ST, BELLEVILLE, KS 66935-2209
(785) 527-8271
(785) 527-8317
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5074
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201153590A
—
KS
Enumeration date
06/14/2016
Last updated
05/14/2020
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