Provider Demographics
NPI:1396416525
Name:BENSON, SAMANTHA (MPH, RD, LD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:JOCHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RD, LD
Mailing Address - Street 1:715 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1210
Mailing Address - Country:US
Mailing Address - Phone:612-873-9909
Mailing Address - Fax:
Practice Address - Street 1:715 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1210
Practice Address - Country:US
Practice Address - Phone:612-873-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered