Provider Demographics
NPI:1023687068
Name:FIENUP, BENJAMIN RUSSELL (MC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RUSSELL
Last Name:FIENUP
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 ELMRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-5404
Mailing Address - Country:US
Mailing Address - Phone:319-504-5982
Mailing Address - Fax:
Practice Address - Street 1:1203 ELMRIDGE DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-5404
Practice Address - Country:US
Practice Address - Phone:319-504-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108949101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health