Provider Demographics
NPI:1134281082
Name:HENDERSON, TERRY L DREW (MA-CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:L DREW
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ANNAWAN RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-2138
Mailing Address - Country:US
Mailing Address - Phone:617-244-6455
Mailing Address - Fax:617-969-5575
Practice Address - Street 1:67 ANNAWAN RD
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-2138
Practice Address - Country:US
Practice Address - Phone:617-244-6455
Practice Address - Fax:617-969-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist