Provider Demographics
NPI:1356738843
Name:BENSON, JOLEEN DALISE (HIS)
Entity type:Individual
Prefix:MRS
First Name:JOLEEN
Middle Name:DALISE
Last Name:BENSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3953 LEGION LN
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-1942
Mailing Address - Country:US
Mailing Address - Phone:307-237-5813
Mailing Address - Fax:307-237-2329
Practice Address - Street 1:3953 LEGION LN
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-1942
Practice Address - Country:US
Practice Address - Phone:307-237-5813
Practice Address - Fax:307-237-2329
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY164237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist