Healthcare Provider Details

I. General information

NPI: 1578338729
Provider Name (Legal Business Name): AMANDA J BENSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 COVENANT CT
TIMNATH CO
80547-5821
US

IV. Provider business mailing address

PO BOX 271863
FORT COLLINS CO
80527-1863
US

V. Phone/Fax

Practice location:
  • Phone: 970-568-6926
  • Fax:
Mailing address:
  • Phone: 970-568-6926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number383
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW13411
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: