MEDICARE: CHALEAH JAMIECE BENNETT

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	171M00000X	Case Manager/Care Coordinator
2	175T00000X	Peer Specialist	005495

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760168629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHALEAH JAMIECE BENNETT

Provider Business Mailing Address
First Line	:	875 E COLUMBUS ST
Second Line	:
City	:	KENTON
State	:	OH
Zip	:	43326-2601
Country	:	US
Telephone Number	:	937-977-3340
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 E COLUMBUS ST
Second Line	:
City	:	KENTON
State	:	OH
Zip	:	43326-2601
Country	:	US
Telephone Number	:	937-977-3340
Fax Number	:

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

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	12/03/2025

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