Provider Demographics
NPI:1740877364
Name:BENJAMIN, HEIDI HERNDON (MED)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:HERNDON
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MED
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 1245
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-1260
Mailing Address - Country:US
Mailing Address - Phone:509-332-0451
Mailing Address - Fax:
Practice Address - Street 1:600 SW FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2154
Practice Address - Country:US
Practice Address - Phone:509-332-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60576756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty