Healthcare Provider Details

I. General information

NPI: 1336083096
Provider Name (Legal Business Name): CHELSEA CATHRINE BENHAM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 RESEARCH PARK DR STE B1-A
ANN ARBOR MI
48108-2229
US

IV. Provider business mailing address

4969 W PITCH PINE LN APT 1B
YPSILANTI MI
48197-4970
US

V. Phone/Fax

Practice location:
  • Phone: 734-794-2930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: