Provider Demographics
NPI:1295031466
Name:BENDER, CARL JAMES (MA)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:JAMES
Last Name:BENDER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5770
Mailing Address - Country:US
Mailing Address - Phone:530-877-6679
Mailing Address - Fax:
Practice Address - Street 1:1200 SPRINGFIELD DR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-6340
Practice Address - Country:US
Practice Address - Phone:530-342-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist