Provider Demographics
NPI:1053683193
Name:BENDERSON, ILONA (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:
Last Name:BENDERSON
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 ANDREW HILL RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2057
Mailing Address - Country:US
Mailing Address - Phone:410-802-4985
Mailing Address - Fax:
Practice Address - Street 1:3407 OLANWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2057
Practice Address - Country:US
Practice Address - Phone:410-802-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist