Provider Demographics
NPI:1104386788
Name:BENDER, KRISTEN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:BENDER
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 1:3441 BILLY RAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3749
Mailing Address - Country:US
Mailing Address - Phone:817-705-8168
Mailing Address - Fax:
Practice Address - Street 1:220 DAVENPORT
Practice Address - Street 2:
Practice Address - City:ITALY
Practice Address - State:TX
Practice Address - Zip Code:76651-3592
Practice Address - Country:US
Practice Address - Phone:972-483-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist