Provider Demographics
NPI:1629134069
Name:AWENDER, DENISE G
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:G
Last Name:AWENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11124 83RD ST SE
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-9700
Mailing Address - Country:US
Mailing Address - Phone:701-742-3421
Mailing Address - Fax:
Practice Address - Street 1:232 3RD ST NE
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3014
Practice Address - Country:US
Practice Address - Phone:701-845-3402
Practice Address - Fax:701-845-3408
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND56143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50875Medicaid