Provider Demographics
NPI:1962664805
Name:BENTON, KARI KRISTIN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:KRISTIN
Last Name:BENTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 N SCHUMANN AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4740
Mailing Address - Country:US
Mailing Address - Phone:208-982-1190
Mailing Address - Fax:
Practice Address - Street 1:1406 N MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1746
Practice Address - Country:US
Practice Address - Phone:208-982-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID392771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical