Provider Demographics
NPI:1639718463
Name:BENNION, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BENNION
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 1:376 S 740 W UNIT 104
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2266
Mailing Address - Country:US
Mailing Address - Phone:801-362-0646
Mailing Address - Fax:
Practice Address - Street 1:20 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042
Practice Address - Country:US
Practice Address - Phone:801-441-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)