Provider Demographics
NPI:1376298042
Name:FENDER, HELEN RACHEL (EDS, IPE)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:RACHEL
Last Name:FENDER
Suffix:
Gender:F
Credentials:EDS, IPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 W CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-9508
Mailing Address - Country:US
Mailing Address - Phone:812-369-5052
Mailing Address - Fax:
Practice Address - Street 1:9330 W CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-9508
Practice Address - Country:US
Practice Address - Phone:812-369-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1311061103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool