Provider Demographics
NPI:1083398614
Name:BIENZ, VIOLET VIRGINIA
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:VIRGINIA
Last Name:BIENZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 E 20TH ST APT 16
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1565
Mailing Address - Country:US
Mailing Address - Phone:574-575-5704
Mailing Address - Fax:812-822-2496
Practice Address - Street 1:2010 S YOST AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3188
Practice Address - Country:US
Practice Address - Phone:812-822-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-23-27-6857106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician