Provider Demographics
NPI:1992513915
Name:CORDES, BENNETT ELIZABETH (QMHA)
Entity type:Individual
Prefix:
First Name:BENNETT
Middle Name:ELIZABETH
Last Name:CORDES
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 TERREL DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-8140
Mailing Address - Country:US
Mailing Address - Phone:458-226-5347
Mailing Address - Fax:
Practice Address - Street 1:2240 TERREL DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-8140
Practice Address - Country:US
Practice Address - Phone:458-226-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24-QMHA-R-5600225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner