Provider Demographics
NPI:1043040561
Name:BENNINGTON, CLAIRE NICOLE WARREN (LMT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:NICOLE WARREN
Last Name:BENNINGTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 ARI AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-7074
Mailing Address - Country:US
Mailing Address - Phone:425-417-9746
Mailing Address - Fax:
Practice Address - Street 1:1400 ARI AVE
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-7074
Practice Address - Country:US
Practice Address - Phone:425-417-9746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1616704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist