Provider Demographics
NPI:1003020850
Name:BENOIT BREKHUS, JOELLE MARIE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:MARIE
Last Name:BENOIT BREKHUS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JOELLE
Other - Middle Name:MARIE
Other - Last Name:BENOIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:519 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1804
Mailing Address - Country:US
Mailing Address - Phone:509-754-6387
Mailing Address - Fax:
Practice Address - Street 1:1519 BASIN ST SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2135
Practice Address - Country:US
Practice Address - Phone:509-754-2461
Practice Address - Fax:509-754-2462
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019749225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0190967OtherL&I