Provider Demographics
NPI:1912129867
Name:BENHOFF, PAMELA N
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:N
Last Name:BENHOFF
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 1:1665 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1791
Mailing Address - Country:US
Mailing Address - Phone:618-526-8830
Mailing Address - Fax:618-526-8831
Practice Address - Street 1:1665 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1791
Practice Address - Country:US
Practice Address - Phone:618-526-8830
Practice Address - Fax:618-526-8831
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist