Provider Demographics
NPI:1124516307
Name:BENTSON, RONNI L
Entity type:Individual
Prefix:
First Name:RONNI
Middle Name:L
Last Name:BENTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RONNI
Other - Middle Name:L
Other - Last Name:HEMSTREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 SILVER PINE CIR APT 20
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9804
Mailing Address - Country:US
Mailing Address - Phone:941-281-9482
Mailing Address - Fax:
Practice Address - Street 1:940 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9318
Practice Address - Country:US
Practice Address - Phone:844-244-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician