Provider Demographics
NPI:1639444771
Name:BENZ, MARY ASHLEY (MA, CLC, LCCE, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ASHLEY
Last Name:BENZ
Suffix:
Gender:F
Credentials:MA, CLC, LCCE, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 ROBERT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2523
Mailing Address - Country:US
Mailing Address - Phone:502-819-9205
Mailing Address - Fax:
Practice Address - Street 1:11512 ROBERT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2523
Practice Address - Country:US
Practice Address - Phone:502-819-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11126823174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula