Provider Demographics
NPI:1558539106
Name:BENNER, ALISON MICHELLE (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MICHELLE
Last Name:BENNER
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:MICHELLE
Other - Last Name:LEGRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD,CCC-A
Mailing Address - Street 1:2450 NE MARY ROSE PL STE 120
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7132
Mailing Address - Country:US
Mailing Address - Phone:541-312-6799
Mailing Address - Fax:541-385-4935
Practice Address - Street 1:2450 NE MARY ROSE PL STE 120
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7132
Practice Address - Country:US
Practice Address - Phone:541-312-6799
Practice Address - Fax:541-385-4935
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023177237700000X
MO2007019394231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist