Provider Demographics
NPI:1356586713
Name:STEVEN A. BENSON PHD, LLC
Entity type:Organization
Organization Name:STEVEN A. BENSON PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-848-0002
Mailing Address - Street 1:500 THIRD STREET
Mailing Address - Street 2:SUITE 319B
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4857
Mailing Address - Country:US
Mailing Address - Phone:715-848-0002
Mailing Address - Fax:715-848-0390
Practice Address - Street 1:500 3RD ST
Practice Address - Street 2:SUITE 319B
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4885
Practice Address - Country:US
Practice Address - Phone:715-848-0002
Practice Address - Fax:715-848-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI390-86-300Medicaid
WI390-86-300Medicaid