Individual
JUNE MARIE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3680 MIDWAY DR, BAKER CITY, OR 97814-1466
(541) 523-4049
(541) 523-4062
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
23-QMHA-R-3992
OR
171M00000X
Case Manager/Care Coordinator
PENDING
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3305578
DRIVERS LICENSE
OR
Enumeration date
06/12/2023
Last updated
07/13/2023
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