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Individual

JAIME BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
720 14TH AVE, LONGVIEW, WA 98632-2315
(360) 423-0203
Mailing address
921 14TH AVE, LONGVIEW, WA 98632-2316
(360) 423-0203
(360) 577-0269

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
60934603
WA

Other

Enumeration date
02/05/2019
Last updated
02/05/2019
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Product
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