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General NPI Number Information
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NPI Number | 1316721723
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Entity Type | Individual
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Provider Name | JENNIFER LYNN BEHNKE
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Gender | Female
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 229 RED COACH DR STE 107
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City | MISHAWAKA
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State | IN
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Zip | 46545-3195
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Country | US
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Telephone | 574-318-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 65225 MIAMI RD
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City | BREMEN
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State | IN
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Zip | 46506-8946
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Country | US
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Telephone | 239-324-7625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT22308084
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License Number State | IN
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