Provider Demographics
NPI:1699101329
Name:BENNING, BRENDA (LGSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BENNING
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 HARBOR LN N
Mailing Address - Street 2:SUITE 316
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5119
Mailing Address - Country:US
Mailing Address - Phone:763-553-0344
Mailing Address - Fax:763-553-0117
Practice Address - Street 1:3025 HARBOR LN N
Practice Address - Street 2:SUITE 316
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55447-5119
Practice Address - Country:US
Practice Address - Phone:763-553-0344
Practice Address - Fax:763-553-0117
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20559104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker