Provider Demographics
NPI:1992227755
Name:BENDER, KERRY HANNON (EDD, SLP)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:HANNON
Last Name:BENDER
Suffix:
Gender:F
Credentials:EDD, SLP
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:MARIE
Other - Last Name:HANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:315 STATEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021
Mailing Address - Country:US
Mailing Address - Phone:341-315-6908
Mailing Address - Fax:
Practice Address - Street 1:16216 BAXTER RD STE 330
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4778
Practice Address - Country:US
Practice Address - Phone:636-733-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61426941235Z00000X
MO2016026846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist