Healthcare Provider Details

I. General information

NPI: 1821914219
Provider Name (Legal Business Name): ANDRIA BENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 N MAIN ST
AMHERST WI
54406-9102
US

IV. Provider business mailing address

357 N MAIN ST
AMHERST WI
54406-9102
US

V. Phone/Fax

Practice location:
  • Phone: 715-824-5521
  • Fax:
Mailing address:
  • Phone: 715-824-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: