Active NPI
Natalie Marie Bennett, PHD
- Clinical Psychologist
- Medford, OR
National Provider Identifier
1013438696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3412
- Practice address
- 840 Royal Ave Ste 110
Medford, OR 97504-6461 - Phone
- (541) 732-8370
- NPI assigned
- Jul 4, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY0964 | NV | |
| Clinical Psychologist | 103TC0700X | 3412 | OR | Primary |
Addresses
Primary practice location
840 Royal Ave Ste 110
Medford, OR 97504-6461
Mailing address
840 Royal Ave Ste 110
Medford, OR 97504-6461
Phone (541) 732-8370
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | nbennett1791704@oc.providencedirect.org | ||
| Direct Messaging Address | nbennett1791704@oc.providencedirect.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY0964 | NV | MD | Clinical Psychologist |
| 3412 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1499126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634947200000",
"number": "1013438696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 ROYAL AVE STE 110",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975046461",
"telephone_number": "541-732-8370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 ROYAL AVE STE 110",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975046461",
"telephone_number": "541-732-8370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "NATALIE",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-04",
"last_updated": "2021-10-23",
"certification_date": "2021-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NV",
"license": "PY0964",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "3412",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "nbennett1791704@oc.providencedirect.org",
"affiliation": "N",
"address_1": "1661 Highway 99 N Ste 100",
"city": "Ashland",
"state": "OR",
"country_code": "US",
"postal_code": "975208900",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "nbennett1791704@oc.providencedirect.org",
"affiliation": "N",
"address_1": "840 Royal Ave Ste 110",
"city": "Medford",
"state": "OR",
"country_code": "US",
"postal_code": "975046461",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.