Healthcare Provider Details

I. General information

NPI: 1407488026
Provider Name (Legal Business Name): BENNI SCALLION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 SE OTIS CORLEY DR STE 11
BENTONVILLE AR
72712-3414
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 479-339-9678
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-832-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-110575
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59052
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: