Provider Demographics
NPI:1962003830
Name:BENNETT, LAUREN MARIE (CACI)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 MARSH LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5969
Mailing Address - Country:US
Mailing Address - Phone:315-725-5918
Mailing Address - Fax:
Practice Address - Street 1:3100 S CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7516
Practice Address - Country:US
Practice Address - Phone:907-452-1648
Practice Address - Fax:907-456-4849
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator