Provider Demographics
NPI:1043046493
Name:BENSON, HANNAH ROSE (MA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:BENSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HEENAN ST
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:IN
Mailing Address - Zip Code:46730-1006
Mailing Address - Country:US
Mailing Address - Phone:630-877-7760
Mailing Address - Fax:
Practice Address - Street 1:1400 AIRPORT NORTH OFFICE PARK STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6723
Practice Address - Country:US
Practice Address - Phone:260-702-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN1-24-77807103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health