Provider Demographics
NPI:1518150259
Name:BENKERT, KIMBERLY K (RDH, BSDH, MPH, COM)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:K
Last Name:BENKERT
Suffix:
Gender:F
Credentials:RDH, BSDH, MPH, COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 CREST RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5401
Mailing Address - Country:US
Mailing Address - Phone:708-309-3844
Mailing Address - Fax:630-790-5517
Practice Address - Street 1:161 CREST RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5401
Practice Address - Country:US
Practice Address - Phone:708-309-3844
Practice Address - Fax:630-790-5517
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020003137124Q00000X
05C79225500000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental Hygienist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty