Provider Demographics
NPI:1164298634
Name:HENDERSON, JOANN SIRACUSA (LISW-S)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:SIRACUSA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1664
Mailing Address - Country:US
Mailing Address - Phone:440-382-4837
Mailing Address - Fax:
Practice Address - Street 1:5520 RIDGE LN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1664
Practice Address - Country:US
Practice Address - Phone:440-382-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health