Provider Demographics
NPI:1003232521
Name:BENDO, TERRY
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:BENDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 DELIA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1326
Mailing Address - Country:US
Mailing Address - Phone:330-865-0429
Mailing Address - Fax:
Practice Address - Street 1:1372 DELIA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1326
Practice Address - Country:US
Practice Address - Phone:330-761-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1-00-6038 JJQK140103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool