Provider Demographics
NPI:1417416553
Name:BENEDICT, JENNIFER ELIZABETH (MAT, AT, ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:MAT, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:SPRING ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49283-9709
Mailing Address - Country:US
Mailing Address - Phone:313-590-0081
Mailing Address - Fax:
Practice Address - Street 1:130 MELODY LN
Practice Address - Street 2:
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9709
Practice Address - Country:US
Practice Address - Phone:313-590-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010021412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer