Provider Demographics
NPI:1619556073
Name:BENTZ, LALONIE LAQUETTA (LICSWA)
Entity Type:Individual
Prefix:
First Name:LALONIE
Middle Name:LAQUETTA
Last Name:BENTZ
Suffix:
Gender:F
Credentials:LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 E HILLS CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5352
Mailing Address - Country:US
Mailing Address - Phone:509-593-0998
Mailing Address - Fax:
Practice Address - Street 1:3326 E HILLS CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5352
Practice Address - Country:US
Practice Address - Phone:509-593-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW613562421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty