Provider Demographics
NPI:1710426788
Name:BENDALL, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BENDALL
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 1:75 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-1118
Mailing Address - Country:US
Mailing Address - Phone:937-605-3416
Mailing Address - Fax:
Practice Address - Street 1:7373 DAYTON SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:ENON
Practice Address - State:OH
Practice Address - Zip Code:45323-1462
Practice Address - Country:US
Practice Address - Phone:937-605-3416
Practice Address - Fax:937-340-7004
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2304838104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker