Provider Demographics
NPI:1053603761
Name:BENIEK, STEFANIE ROSE (LAC, DIPL OM, MOM)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ROSE
Last Name:BENIEK
Suffix:
Gender:F
Credentials:LAC, DIPL OM, MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4748 CHICAGO AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-4320
Mailing Address - Country:US
Mailing Address - Phone:612-805-8131
Mailing Address - Fax:
Practice Address - Street 1:4748 CHICAGO AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4310
Practice Address - Country:US
Practice Address - Phone:612-805-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1536171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist