Provider Demographics
NPI:1831333152
Name:BENWAY, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BENWAY
Suffix:
Gender:F
Credentials:
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 6213
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-6213
Mailing Address - Country:US
Mailing Address - Phone:916-337-2334
Mailing Address - Fax:916-985-4964
Practice Address - Street 1:550 PLAZA DR STE 130
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4779
Practice Address - Country:US
Practice Address - Phone:916-337-2334
Practice Address - Fax:916-985-4964
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist