Provider Demographics
NPI:1780915306
Name:BENCICH-WLOCH, JUDITH JOSEPHINE (MS)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:JOSEPHINE
Last Name:BENCICH-WLOCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23366 FARMINGTON RD
Mailing Address - Street 2:WILLIAMS FAMILY SPORTS & MEDICAL CENTER.
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3102
Mailing Address - Country:US
Mailing Address - Phone:248-476-3333
Mailing Address - Fax:248-476-7123
Practice Address - Street 1:23366 FARMINGTON RD
Practice Address - Street 2:WILLIAMS FAMILY SPORTS & MEDICAL CENTER.
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3102
Practice Address - Country:US
Practice Address - Phone:248-476-3333
Practice Address - Fax:248-476-7123
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist