Provider Demographics
NPI:1154814150
Name:HENDERSON, KRISTEN LEIGH
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:LEIGH
Last Name:HENDERSON
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 1:3433 AGLER RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3397
Mailing Address - Country:US
Mailing Address - Phone:614-600-2708
Mailing Address - Fax:614-476-6708
Practice Address - Street 1:3433 AGLER RD STE 2000
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3397
Practice Address - Country:US
Practice Address - Phone:614-600-2708
Practice Address - Fax:614-476-6708
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator