Provider Demographics
NPI:1871217133
Name:BENSON, EMILY CATHERINE I
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CATHERINE
Last Name:BENSON
Suffix:I
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 1:1190 VANTAGE LN
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-3518
Mailing Address - Country:US
Mailing Address - Phone:810-223-8374
Mailing Address - Fax:
Practice Address - Street 1:1190 VANTAGE LN
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-3518
Practice Address - Country:US
Practice Address - Phone:810-223-8374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional