Provider Demographics
NPI:1942959689
Name:BENTON, GRACIE ABIGAIL (BCBA)
Entity Type:Individual
Prefix:
First Name:GRACIE
Middle Name:ABIGAIL
Last Name:BENTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-7636
Mailing Address - Country:US
Mailing Address - Phone:515-822-3950
Mailing Address - Fax:
Practice Address - Street 1:13300 HICKMAN RD STE 110
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8616
Practice Address - Country:US
Practice Address - Phone:515-987-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst