Provider Demographics
NPI:1992034078
Name:BENKARD, JAMES (LCSW, CSAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BENKARD
Suffix:
Gender:M
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 LA CROSSE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4802
Mailing Address - Country:US
Mailing Address - Phone:608-469-8170
Mailing Address - Fax:
Practice Address - Street 1:3741 WI-138
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589
Practice Address - Country:US
Practice Address - Phone:608-469-8170
Practice Address - Fax:608-873-1929
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15651-132101YA0400X
WI15552-131101YA0400X
WI8914-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992034078Medicaid