Provider Demographics
NPI:1033589528
Name:MCHENRY, LOUISA (BS, MED)
Entity Type:Individual
Prefix:MS
First Name:LOUISA
Middle Name:
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:BS, MED
Other - Prefix:MS
Other - First Name:L.
Other - Middle Name:BETH
Other - Last Name:MCHENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, MED
Mailing Address - Street 1:1315 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-4446
Mailing Address - Country:US
Mailing Address - Phone:903-794-2705
Mailing Address - Fax:903-793-1203
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4446
Practice Address - Country:US
Practice Address - Phone:903-794-2705
Practice Address - Fax:903-793-1203
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX393682355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX#39368OtherSPEECH THERAPY ASSISTANT LICENSE