Provider Demographics
NPI:1013285832
Name:MENARD, BENJAMIN PAUL (LICSW)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:PAUL
Last Name:MENARD
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48597
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-1597
Mailing Address - Country:US
Mailing Address - Phone:509-850-0512
Mailing Address - Fax:
Practice Address - Street 1:9505 N DIVISION ST STE 210
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1232
Practice Address - Country:US
Practice Address - Phone:509-850-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610153811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical