Provider Demographics
NPI:1215809249
Name:BENWAY, JENNIFER ELLA
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLA
Last Name:BENWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N WESTPHALIA ST
Mailing Address - Street 2:PO BOX 192
Mailing Address - City:WESTPHALIA
Mailing Address - State:MI
Mailing Address - Zip Code:48894
Mailing Address - Country:US
Mailing Address - Phone:989-506-4455
Mailing Address - Fax:
Practice Address - Street 1:302 N WESTPHALIA ST
Practice Address - Street 2:PO BOX 192
Practice Address - City:WESTPHALIA
Practice Address - State:MI
Practice Address - Zip Code:48894
Practice Address - Country:US
Practice Address - Phone:989-506-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011202671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical