Provider Demographics
NPI:1497915656
Name:BENDER, LEA ANN (MS CCC)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:ANN
Last Name:BENDER
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S JAY ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-7155
Mailing Address - Country:US
Mailing Address - Phone:605-626-3359
Mailing Address - Fax:605-626-3360
Practice Address - Street 1:1200 S JAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-7155
Practice Address - Country:US
Practice Address - Phone:605-626-3359
Practice Address - Fax:605-626-3360
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD18614-7235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist