| Doctor Name: | MS. PENNY MAIN-BENNETT |
| NPI Number: | 1780710442 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC |
| License Number: | 300832 |
| Business Practice Address: | 16525 Highway 65 Ne Ham Lake X, MN - 553045300 |
| Business Phone Number: | 7634138838 |
| Business Fax Number: | 7634138878 |
| Mailing Address: | 4003 Sunshine Dr, ANOKA |
| State: | MN |
| Postal Code: | 553038606 |
| Phone Number: | 7634138838 |
| Fax Number: | 7634138878 |
| NPI Enumeration Date: | 02/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 300832 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |