Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6361003550 | MI |
N | 103T00000X | Psychologist | 6361003550 | MI |
Y | 103G00000X | Clinical Psychologist | 6361003550 | MI |
Y | 103TC0700X | Clinical Psychologist | 6361003550 | MI |
NPI | 1013258904 |
---|---|
Provider Name | Juanika L Benson |
First Address | Detroit, MI 48211-2026 |
Second Address | Detroit, MI 48211-2026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2013 |
Last Update Date | 02/07/2020 |