Provider Demographics
NPI:1740624303
Name:BENDER, MOLLY KAY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KAY
Last Name:BENDER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 HAINES RD N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-3242
Mailing Address - Country:US
Mailing Address - Phone:727-235-5439
Mailing Address - Fax:
Practice Address - Street 1:1815 77TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4800
Practice Address - Country:US
Practice Address - Phone:727-570-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022389-1235Z00000X
FLSA11480235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist