Individual
DIZERA LOUISE BENHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13838 SW 500TH RD, COLONY, KS 66015-9233
(620) 215-9883
Mailing address
1649 61ST ST, ST. 301, 3RD FL, BROOKLYN, NY 11204-3319
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/06/2025
Last updated
06/13/2025
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