Basic Information
| Provider Information | |||||||||
| NPI: | 1700244688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENTON | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | ELISE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SPANGLER | ||||||||
| OtherFirstName: | HANNAH | ||||||||
| OtherMiddleName: | ELISE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2865 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432042643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143848093 | ||||||||
| FaxNumber: | 6143848097 | ||||||||
| Practice Location | |||||||||
| Address1: | 2865 W BROAD ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432042643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143848093 | ||||||||
| FaxNumber: | 6143848097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I.1440223.SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.