=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316888761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUR CORNERS NEUROPSYCHOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2026
-----------------------------------------------------
Last Update Date | 04/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7925 PARAGON RD STE 100
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-251-7990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7925 PARAGON RD STE 100
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-251-7990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL NEUROPSYCHOLOGIST
-----------------------------------------------------
Name | DR. ERICA BENFIELD
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 937-251-7990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------