Provider Demographics
NPI:1386030807
Name:BENDER, LEANNA (SLP)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:
Other - Last Name:HASENMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:602 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1124
Mailing Address - Country:US
Mailing Address - Phone:563-293-1655
Mailing Address - Fax:
Practice Address - Street 1:602 12TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1124
Practice Address - Country:US
Practice Address - Phone:563-293-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074284235Z00000X
FLSZ7066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist