Provider Demographics
NPI:1093462624
Name:BELLAND, BENJAMIN JARROD (CG61278602)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JARROD
Last Name:BELLAND
Suffix:
Gender:M
Credentials:CG61278602
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-1299
Mailing Address - Country:US
Mailing Address - Phone:360-771-0482
Mailing Address - Fax:360-397-7477
Practice Address - Street 1:21810 NE 37TH AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-7747
Practice Address - Country:US
Practice Address - Phone:360-771-0482
Practice Address - Fax:360-397-7477
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61278602175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist