Provider Demographics
NPI:1013200856
Name:BENSON, MELODEE JEAN (LADC)
Entity type:Individual
Prefix:MS
First Name:MELODEE
Middle Name:JEAN
Last Name:BENSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 BOTTINEAU BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3184
Mailing Address - Country:US
Mailing Address - Phone:763-330-2774
Mailing Address - Fax:763-330-2775
Practice Address - Street 1:5700 BOTTINEAU BLVD STE 210
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3184
Practice Address - Country:US
Practice Address - Phone:633-302-7747
Practice Address - Fax:763-330-2775
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional