Provider Demographics
NPI:1609437748
Name:BENN, ISABELLA KAI
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:KAI
Last Name:BENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S THOR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4855
Mailing Address - Country:US
Mailing Address - Phone:509-532-2000
Mailing Address - Fax:509-532-2005
Practice Address - Street 1:22 S THOR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4855
Practice Address - Country:US
Practice Address - Phone:509-532-2000
Practice Address - Fax:509-532-2005
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60978590171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator