Provider Demographics
NPI:1114292174
Name:HENDERSON, KYLEE M (CSW)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:M
Other - Last Name:DEGLAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:7 GLASSWORKS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:15338-9507
Mailing Address - Country:US
Mailing Address - Phone:724-943-3308
Mailing Address - Fax:724-943-3310
Practice Address - Street 1:7 GLASSWORKS RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:PA
Practice Address - Zip Code:15338-9507
Practice Address - Country:US
Practice Address - Phone:724-943-3308
Practice Address - Fax:724-943-3310
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor