Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3657-57 | WI |
Y | 103T00000X | Psychologist | 3657-57 | WI |
N | 103TC1900X | Counseling Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TH0004X | Health Psychologist |
NPI | 1417472341 |
---|---|
Provider Name | Julia Zepnick Benjamin |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2017 |
Last Update Date | 11/01/2021 |