Provider Demographics
NPI:1487807046
Name:BENDER, SHANNON LYNN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LYNN
Last Name:BENDER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:40 FOREST GLEN RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1200
Mailing Address - Country:US
Mailing Address - Phone:845-548-1673
Mailing Address - Fax:845-268-3205
Practice Address - Street 1:40 FOREST GLEN RD
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1200
Practice Address - Country:US
Practice Address - Phone:845-548-1673
Practice Address - Fax:845-268-3205
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0146781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist