Provider Demographics
NPI:1073297693
Name:SONCARTY, BENNETT
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:
Last Name:SONCARTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 GEORGIA AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3772
Mailing Address - Country:US
Mailing Address - Phone:563-343-7768
Mailing Address - Fax:
Practice Address - Street 1:1315 S BELL AVE STE 108
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-7730
Practice Address - Country:US
Practice Address - Phone:515-337-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician