Provider Demographics
NPI:1194024794
Name:HENDERSON, JODI ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANNETTE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 WARMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-1264
Mailing Address - Country:US
Mailing Address - Phone:256-483-2100
Mailing Address - Fax:
Practice Address - Street 1:541 WARMINSTER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-1264
Practice Address - Country:US
Practice Address - Phone:256-483-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040085151041C0700X
TN55641041C0700X
AL2241C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical