Provider Demographics
NPI:1073198057
Name:HENDRICKSON, LINDA LEE (HAIR REPLACEMENT SPE)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1924
Mailing Address - Country:US
Mailing Address - Phone:330-289-5670
Mailing Address - Fax:
Practice Address - Street 1:1716 FALLS AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1924
Practice Address - Country:US
Practice Address - Phone:330-289-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier