Provider Demographics
NPI:1043573116
Name:HENDERSON, CHERYL ANITA (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANITA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:ANITA
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-A
Mailing Address - Street 1:655 KENMOOR AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8622
Mailing Address - Country:US
Mailing Address - Phone:616-575-1208
Mailing Address - Fax:616-575-1219
Practice Address - Street 1:655 KENMOOR AVE SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8622
Practice Address - Country:US
Practice Address - Phone:616-575-1208
Practice Address - Fax:616-575-1219
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000158237600000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter