Healthcare Provider Details

I. General information

NPI: 1053688309
Provider Name (Legal Business Name): PENNY L BENDORF PLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W NORFOLK AVE SUITE 201
NORFOLK NE
68701-5219
US

IV. Provider business mailing address

333 W NORFOLK AVE SUITE 201
NORFOLK NE
68701-5219
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-2030
  • Fax: 402-379-3933
Mailing address:
  • Phone: 402-379-2030
  • Fax: 402-379-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-924
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: