Healthcare Provider Details

I. General information

NPI: 1396076477
Provider Name (Legal Business Name): SHANNON LOUISE BENNETT LM,CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 SMITTY DR
RICHLAND WA
99352-8009
US

IV. Provider business mailing address

5002 SMITTY DR
RICHLAND WA
99352-8009
US

V. Phone/Fax

Practice location:
  • Phone: 509-308-3711
  • Fax: 509-212-4523
Mailing address:
  • Phone: 509-308-3711
  • Fax: 509-212-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: