Provider Demographics
NPI:1053562827
Name:BENSON, JUDY L (LMP)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:L
Last Name:BENSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7532
Mailing Address - Country:US
Mailing Address - Phone:360-487-0212
Mailing Address - Fax:
Practice Address - Street 1:11015 NE FOURTH PLAIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6314
Practice Address - Country:US
Practice Address - Phone:360-892-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60041420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist