Provider Demographics
NPI:1497031306
Name:BENDER, LISA JEAN (MASTERS DEGREE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:BENDER
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 VIOLA AVENUE
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-4411
Mailing Address - Country:US
Mailing Address - Phone:845-895-7225
Mailing Address - Fax:
Practice Address - Street 1:137 VIOLA ST
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-4414
Practice Address - Country:US
Practice Address - Phone:845-895-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist