Provider Demographics
NPI:1508019365
Name:SHANNON L. BENDER, M.S., CCC-SLP, LLC
Entity Type:Organization
Organization Name:SHANNON L. BENDER, M.S., CCC-SLP, LLC
Other - Org Name:CHILDREN'S HOME THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:845-709-5181
Mailing Address - Street 1:40 FOREST GLEN RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989
Mailing Address - Country:US
Mailing Address - Phone:845-709-5181
Mailing Address - Fax:845-268-3205
Practice Address - Street 1:40 FOREST GLEN RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1200
Practice Address - Country:US
Practice Address - Phone:845-709-5181
Practice Address - Fax:845-268-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0146781252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency