MEDICARE: ASHLEY VERONICA BENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	LBA0168	MN

General Provider Information

NPI Number	:	1104408947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY VERONICA BENSON

Provider Business Mailing Address
First Line	:	260 2ND AVENUE CT SW
Second Line	:
City	:	RICE
State	:	MN
Zip	:	56367-8827
Country	:	US
Telephone Number	:	708-586-2604
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 S HARLEM AVE
Second Line	:
City	:	WORTH
State	:	IL
Zip	:	60482-2001
Country	:	US
Telephone Number	:	708-586-2604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	10/20/2025

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Directions to “ ASHLEY VERONICA BENSON ” Practice Location

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