Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | UA1016164 | OH |
NPI | 1033501358 |
---|---|
Provider Name | Lisa Marie Bender |
First Address | Canton, OH 44709-2312 |
Second Address | Canton, OH 44709-2312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2015 |
Last Update Date | 24/02/2015 |