Provider Demographics
NPI:1073972592
Name:HENDERSHOT, VALERIE (CSA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:HENDERSHOT
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2144
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-2144
Mailing Address - Country:US
Mailing Address - Phone:832-932-5787
Mailing Address - Fax:832-832-5979
Practice Address - Street 1:1322 SPACE PARK DR
Practice Address - Street 2:C-102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3400
Practice Address - Country:US
Practice Address - Phone:832-932-5787
Practice Address - Fax:832-932-5979
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147330246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant