Provider Demographics
NPI:1003214685
Name:BENSON, SHANTREASE
Entity Type:Individual
Prefix:MRS
First Name:SHANTREASE
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 N 40TH ST
Mailing Address - Street 2:PO BOX 100268
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2505
Mailing Address - Country:US
Mailing Address - Phone:414-447-1965
Mailing Address - Fax:414-874-2820
Practice Address - Street 1:2677 N 40TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2505
Practice Address - Country:US
Practice Address - Phone:414-447-1965
Practice Address - Fax:414-874-2820
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)