MEDICARE: STEVEN A. BENSON PHD, LLC

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	103TC0700X	Clinical Psychologist	1327	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356586713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN A. BENSON PHD, LLC

Provider Business Mailing Address
First Line	:	500 THIRD STREET
Second Line	:	SUITE 319B
City	:	WAUSAU
State	:	WI
Zip	:	54403-4857
Country	:	US
Telephone Number	:	715-848-0002
Fax Number	:	715-848-0390

Provider Business Practice Location Address
First Line	:	500 3RD ST
Second Line	:	SUITE 319B
City	:	WAUSAU
State	:	WI
Zip	:	54403-4885
Country	:	US
Telephone Number	:	715-848-0002
Fax Number	:	715-848-0390

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN A BENSON
Credential	:	PH.D.
Telephone Number	:	715-848-0002

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	12/12/2008

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