| Doctor Name: | KYLE J BENNER |
| NPI Number: | 1023242708 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 60371397 |
| Business Practice Address: | 7320 216th St Sw Ste 200 Edmonds, WA - 980268006 |
| Business Phone Number: | 4256404900 |
| Business Fax Number: | 4256404919 |
| Mailing Address: | Po Box 25608, SALT LAKE CITY |
| State: | UT |
| Postal Code: | 841250608 |
| Phone Number: | 2063204476 |
| Fax Number: | 2065697043 |
| NPI Enumeration Date: | 05/08/2009 |
| NPI Last Update Date: | 08/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0804X |
| License Number: | 60371397 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Child & Adolescent Psychiatry |
| Taxonomy Definition: | Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |