Healthcare Provider Details

I. General information

NPI: 1124516307
Provider Name (Legal Business Name): RONNI L BENTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RONNI L HEMSTREET

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 S WISCONSIN AVE
GAYLORD MI
49735
US

IV. Provider business mailing address

421 S OAK AVE
GAYLORD MI
49735-1247
US

V. Phone/Fax

Practice location:
  • Phone: 231-268-0360
  • Fax:
Mailing address:
  • Phone: 941-281-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: