Provider Demographics
NPI:1144748385
Name:HENRY, JOHANNA RUTH
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:RUTH
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DRAPER ST APT 307
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-4789
Mailing Address - Country:US
Mailing Address - Phone:501-993-2431
Mailing Address - Fax:
Practice Address - Street 1:1900 AUGUSTA ST.
Practice Address - Street 2:SUITE 2500
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605
Practice Address - Country:US
Practice Address - Phone:864-630-6804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist