Gina Bennett
Individual provider Active NPI Behavior Technician · The Dalles, OR
NPI 1508319385 · NPPES record last updated Oct 18, 2016
Key facts
- NPI
- 1508319385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- ABA-IN-10179260 (OR)
- Practice address
- 309 E 2ND St
The Dalles, OR 97058-2107 - Phone
- (541) 298-2101
- NPI assigned
- Jul 28, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ABA-IN-10179260 | OR | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Oregon Human Services Consortium | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | ABA-IN-10179260 | OR | Yes |
Addresses
Primary practice location
309 E 2ND St
The Dalles, OR 97058-2107
Mailing address
309 E 2ND St
The Dalles, OR 97058-2107
Phone (541) 298-2101
Other providers in The Dalles, OR
- Alexander Penn Barton
- Sary Bassett
- Ramona (Mandie) Bates
- Nicole Beaman
- Patricia (Pat) Jean Beeman
- Kevin Bertadillo
- Jeffrey L Bevan
- James Jeffers Bickler
- Allyson Elizabeth Billings Wickerham
- Kara Billings
All providers in The Dalles, OR · Behavior Technician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.