Shelly R Benshoof, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

850 Issued in NE

Practice address

917 Wildwood Lane
Suite 153
Nebraska City, NE 68410

Phone

(402) 216-0561

Fax

(866) 733-2530

NPI assigned

Jul 26, 2010

Last updated

Feb 5, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Shelly R Ingwerson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391558400000",
    "number": "1689987158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 WILDWOOD LANE",
            "address_2": "SUITE 153",
            "city": "NEBRASKA CITY",
            "state": "NE",
            "postal_code": "68410",
            "telephone_number": "402-216-0561",
            "fax_number": "866-733-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 WILDWOOD LANE",
            "address_2": "SUITE 153",
            "city": "NEBRASKA CITY",
            "state": "NE",
            "postal_code": "68410",
            "telephone_number": "402-216-0561",
            "fax_number": "866-733-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENSHOOF",
        "first_name": "SHELLY",
        "middle_name": "R",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-26",
        "last_updated": "2014-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NE",
            "license": "850",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": "9177",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025465700",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025287200",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "INGWERSON",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Psychologist in Nebraska City, NE
• Providers in Nebraska City, NE by specialty
• Psychologist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.