Provider Demographics
NPI:1124214465
Name:JUDITH A. HENDERSON, INC.
Entity Type:Organization
Organization Name:JUDITH A. HENDERSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:605-373-9066
Mailing Address - Street 1:3710 S KIWANIS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4232
Mailing Address - Country:US
Mailing Address - Phone:605-373-9066
Mailing Address - Fax:605-373-9145
Practice Address - Street 1:3710 S KIWANIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4232
Practice Address - Country:US
Practice Address - Phone:605-373-9066
Practice Address - Fax:605-373-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040725OtherBLUE CROSS BLUE SHIELD
SD6551272Medicaid
SD7878OtherMIDLANDS CHOICE
SD22053OtherSANFORD HEALTH PLAN
SD3052OtherAVERA HEALTH PLANS
SD86734 & HP29926OtherHEALTH PARTNERS
SD106137OtherCHOICE PLUS
SD86734 & HP29926OtherHEALTH PARTNERS