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General NPI Number Information
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NPI Number | 1891513412
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Entity Type | Individual
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Provider Name | CORRYN N BENNION
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Gender | Female
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 6003 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83709-3073
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Country | US
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Telephone | 208-751-0478
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Fax |
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Provider Business Mailing Address
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Address Line | 225 N 1ST W APT 6
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City | SAINT ANTHONY
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State | ID
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Zip | 83445-1451
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Country | US
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Telephone | 702-490-8845
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2161479
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License Number State | ID
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