Provider Demographics
NPI:1225452543
Name:BENDER, LISA (MS CCC-SLP/A)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:MS CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MINERAL SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-1130
Mailing Address - Country:US
Mailing Address - Phone:330-682-1851
Mailing Address - Fax:
Practice Address - Street 1:605 MINERAL SPRINGS ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-1130
Practice Address - Country:US
Practice Address - Phone:330-682-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist