Healthcare Provider Details

I. General information

NPI: 1992227755
Provider Name (Legal Business Name): KERRY HANNON BENDER ED.D, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY MARIE HANNON M.S., SLP

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 STATEWOOD DR
BALLWIN MO
63021-6351
US

IV. Provider business mailing address

315 STATEWOOD DR
BALLWIN MO
63021-6351
US

V. Phone/Fax

Practice location:
  • Phone: 341-315-6908
  • Fax:
Mailing address:
  • Phone: 341-315-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18944
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL61426941
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2016026846
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: