Provider Demographics
NPI:1417287293
Name:BENSON, TOSHA MARLENE (LMP)
Entity Type:Individual
Prefix:
First Name:TOSHA
Middle Name:MARLENE
Last Name:BENSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 NE 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2912
Mailing Address - Country:US
Mailing Address - Phone:360-518-8614
Mailing Address - Fax:
Practice Address - Street 1:14201 NE 20TH AVE
Practice Address - Street 2:SUITE 3101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6410
Practice Address - Country:US
Practice Address - Phone:360-576-8599
Practice Address - Fax:360-576-6320
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024793174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist