Provider Demographics
NPI:1093564726
Name:BENDELE, VERONICA JANE (RBT)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:JANE
Last Name:BENDELE
Suffix:
Gender:X
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 N ACADEMY BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3688
Mailing Address - Country:US
Mailing Address - Phone:719-301-5100
Mailing Address - Fax:
Practice Address - Street 1:1915 AEROTECH DR STE 190
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-4213
Practice Address - Country:US
Practice Address - Phone:719-301-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-24-346906106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1790211605Medicaid