Healthcare Provider Details

I. General information

NPI: 1003891714
Provider Name (Legal Business Name): TRISHA KAY BENDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 COOKS HILL RD
CENTRALIA WA
98531
US

IV. Provider business mailing address

1911 COOKS HILL RD
CENTRALIA WA
98531-9073
US

V. Phone/Fax

Practice location:
  • Phone: 360-623-1163
  • Fax: 360-736-6552
Mailing address:
  • Phone: 360-736-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD60765294
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD60765294
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number12946
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: