Provider Demographics
NPI:1447095054
Name:BENN, MICHELLE (HIS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BENN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KIRCHARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NA
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:507-456-4752
Mailing Address - Fax:
Practice Address - Street 1:13710 METROPOLIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7144
Practice Address - Country:US
Practice Address - Phone:239-208-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist