Provider Demographics
NPI:1154841658
Name:HENDRIX, MAGGIE CLIFFORD (MS)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:CLIFFORD
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:100 E IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6267
Mailing Address - Country:US
Mailing Address - Phone:208-381-6151
Mailing Address - Fax:208-381-3276
Practice Address - Street 1:100 E IDAHO ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6267
Practice Address - Country:US
Practice Address - Phone:208-381-6151
Practice Address - Fax:208-381-3276
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS