Provider Demographics
NPI:1184020349
Name:BENSON, SHERRY LYNN (LCSW, CCPT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:BENSON
Suffix:
Gender:F
Credentials:LCSW, CCPT
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LYNN
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:805 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-3231
Mailing Address - Country:US
Mailing Address - Phone:906-424-4476
Mailing Address - Fax:906-424-4480
Practice Address - Street 1:805 1ST ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-3231
Practice Address - Country:US
Practice Address - Phone:906-424-4476
Practice Address - Fax:906-424-4480
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129573101YM0800X
WI8611-123101YM0800X
MI6801098834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100041647Medicaid