Provider Demographics
NPI:1912376930
Name:FENDER, CHERYL K (MED)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:K
Last Name:FENDER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-4532
Mailing Address - Country:US
Mailing Address - Phone:937-238-7115
Mailing Address - Fax:
Practice Address - Street 1:2251 TIMBER LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4532
Practice Address - Country:US
Practice Address - Phone:937-238-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUD1006420103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist