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NPI Code Detail

MEDICARE: MRS. SHIRLEY R BENSON-ROGERS MS, LADC

MEDICARE: MRS. SHIRLEY R BENSON-ROGERS MS, LADC
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
1101YP2500XProfessional CounselorCC03443MN
2101YA0400XAddiction (Substance Use Disorder) Counselor305600MN

General Provider Information

NPI Number : 1326653601
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHIRLEY R BENSON-ROGERS MS, LADC
Provider Business Mailing Address
First Line : 2118 BLAISDELL AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-2415
Country : US
Telephone Number : 612-235-6259
Fax Number : 612-872-8855
Provider Business Practice Location Address
First Line : 2118 BLAISDELL AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-2415
Country : US
Telephone Number : 612-235-6259
Fax Number : 612-872-8855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2020
Last Update Date : 04/11/2024

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