Healthcare Provider Details

I. General information

NPI: 1811420334
Provider Name (Legal Business Name): JACLYN MARIE BENDER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACLYN MARIE PEICK

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 HIGHLAND BLVD STE 5320
BOZEMAN MT
59715-6916
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5000
  • Fax:
Mailing address:
  • Phone: 612-262-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30050
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMED-PHYS-LIC-162037
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71262
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: