Provider Demographics
NPI:1750703088
Name:BENNICK, MARY ANNE (MA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:BENNICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W GALER ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3393
Mailing Address - Country:US
Mailing Address - Phone:206-686-9441
Mailing Address - Fax:
Practice Address - Street 1:314 W GALER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3393
Practice Address - Country:US
Practice Address - Phone:206-686-9441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health