Provider Demographics
NPI:1013398668
Name:BENDURE, JENNY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:BENDURE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 ADAMS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1007
Mailing Address - Country:US
Mailing Address - Phone:405-701-8400
Mailing Address - Fax:405-253-0490
Practice Address - Street 1:4330 ADAMS RD STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1007
Practice Address - Country:US
Practice Address - Phone:405-701-8400
Practice Address - Fax:405-253-0490
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1250103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK13655858OtherCAQH
OK549544OtherMEDICARE
OK200677510AMedicaid