MEDICARE: SAMIA JEWEL BENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1770414492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIA JEWEL BENSON

Provider Business Mailing Address
First Line	:	313 1/2 W 12TH ST
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 1/2 W 12TH ST
Second Line	:
City	:	WAYNE
State	:	NE
Zip	:	68787-1019
Country	:	US
Telephone Number	:	331-301-9126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “ SAMIA JEWEL BENSON ” Practice Location

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