Provider Demographics
NPI:1720383375
Name:BENDER, EMILY SARA (ND, LAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SARA
Last Name:BENDER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 148TH AVE NE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-7114
Mailing Address - Country:US
Mailing Address - Phone:425-822-0602
Mailing Address - Fax:425-822-2082
Practice Address - Street 1:4205 148TH AVE NE
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-7114
Practice Address - Country:US
Practice Address - Phone:425-822-0602
Practice Address - Fax:425-822-2082
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60176239171100000X
WANT60185817175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist