Provider Demographics
NPI:1104579275
Name:BENTZ, KASEY MIEKO (MSW INTERN)
Entity type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:MIEKO
Last Name:BENTZ
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:MISS
Other - First Name:KASEY
Other - Middle Name:MIEKO
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11405 BOB FINDLAY RD E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-3715
Mailing Address - Country:US
Mailing Address - Phone:253-319-7272
Mailing Address - Fax:253-319-7279
Practice Address - Street 1:11405 BOB FINDLAY RD E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-3715
Practice Address - Country:US
Practice Address - Phone:253-319-7272
Practice Address - Fax:253-319-7279
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 390200000X
WAES60100093146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic