Provider Demographics
NPI:1083818819
Name:HENDRICKSON, LINDA W (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:W
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 SWEETWATER LN
Mailing Address - Street 2:
Mailing Address - City:WARD
Mailing Address - State:AR
Mailing Address - Zip Code:72176-9271
Mailing Address - Country:US
Mailing Address - Phone:501-843-2116
Mailing Address - Fax:
Practice Address - Street 1:800 MARSHALL ST
Practice Address - Street 2:KIDS FIRST POC
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3510
Practice Address - Country:US
Practice Address - Phone:501-364-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist