Provider Demographics
NPI:1275021529
Name:BENDER, ANGELA M
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
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 1:657 E COURT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-4071
Mailing Address - Country:US
Mailing Address - Phone:815-933-2493
Mailing Address - Fax:815-933-0765
Practice Address - Street 1:101 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:AROMA PARK
Practice Address - State:IL
Practice Address - Zip Code:60910-1053
Practice Address - Country:US
Practice Address - Phone:815-933-2493
Practice Address - Fax:815-933-0765
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist