Provider Demographics
NPI:1063734127
Name:BENDER, JEANNE IRENE (MA)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:IRENE
Last Name:BENDER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 5135
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-9509
Mailing Address - Country:US
Mailing Address - Phone:808-936-4374
Mailing Address - Fax:808-966-6290
Practice Address - Street 1:15-1477 22ND AVE.
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-9509
Practice Address - Country:US
Practice Address - Phone:808-936-4374
Practice Address - Fax:808-966-6290
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist