Provider Demographics
NPI:1235304841
Name:HENDERSON, MICHELLE VIOLA
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VIOLA
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 1:29 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:COLLONGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023
Mailing Address - Country:US
Mailing Address - Phone:610-972-2194
Mailing Address - Fax:
Practice Address - Street 1:29 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-2035
Practice Address - Country:US
Practice Address - Phone:484-953-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist