Healthcare Provider Details

I. General information

NPI: 1104325299
Provider Name (Legal Business Name): MEGHAN HAILEY BENZING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 30TH AVE S STE 101
GRAND FORKS ND
58201-6009
US

IV. Provider business mailing address

3301 30TH AVE S STE 101
GRAND FORKS ND
58201-6009
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-9700
  • Fax:
Mailing address:
  • Phone: 701-780-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1331-11-1-23A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: