Provider Demographics
NPI:1558967687
Name:BENTSEN, MARKUS (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MARKUS
Middle Name:
Last Name:BENTSEN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3735
Mailing Address - Country:US
Mailing Address - Phone:509-888-3062
Mailing Address - Fax:509-888-3063
Practice Address - Street 1:1500 S MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3735
Practice Address - Country:US
Practice Address - Phone:509-888-3062
Practice Address - Fax:509-888-3063
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61126473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALL61126473OtherSTATE LIC.