Provider Demographics
NPI:1063613065
Name:BENSON, STEVEN A (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:BENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 3RD ST STE 319-B
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4857
Mailing Address - Country:US
Mailing Address - Phone:715-848-0002
Mailing Address - Fax:715-848-0390
Practice Address - Street 1:500 3RD ST STE 319-B
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4857
Practice Address - Country:US
Practice Address - Phone:715-848-0002
Practice Address - Fax:715-848-0390
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40163OtherNATL REG HEALTH SVC PROVI
WI1327OtherSTATE LICENCE #
WI40163OtherNATL REG HEALTH SVC PROVI