Provider Information for 1134440761
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RYAN BENNION CSW
Sex: Male
NPI: 1134440761
Last Updated: 2024-10-15
Certification Date: 2024-10-15
Certification Date: 2024-10-15
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1134440761 | ||||||||
| Enumeration Date | 2010-06-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 10852 PINE SHADOW RD SOUTH JORDAN, UT 84095-3951 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 500 FOOTHIL DRIVE SALT LAKE CITY, UT 84148-1700 United States Phone: 801-582-1565 | Fax: | ||||||||
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