Provider Demographics
NPI:1598329161
Name:BENSHOFF, OLIVIA (BT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BENSHOFF
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8128 S DEER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5749
Mailing Address - Country:US
Mailing Address - Phone:860-944-1380
Mailing Address - Fax:
Practice Address - Street 1:1111 S 1350 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-3817
Practice Address - Country:US
Practice Address - Phone:801-935-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician