Healthcare Provider Details

I. General information

NPI: 1356257125
Provider Name (Legal Business Name): ELIZABETH BENDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 CENTER RD
BRUNSWICK OH
44212-3617
US

IV. Provider business mailing address

5512 GREY DR
MEDINA OH
44256-8883
US

V. Phone/Fax

Practice location:
  • Phone: 330-225-7731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: