Provider Demographics
NPI:1235516253
Name:HENNINGS, CALLI LORAINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CALLI
Middle Name:LORAINE
Last Name:HENNINGS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 WINDING TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7919
Mailing Address - Country:US
Mailing Address - Phone:813-381-3001
Mailing Address - Fax:
Practice Address - Street 1:2915 WINDING TRAIL DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7919
Practice Address - Country:US
Practice Address - Phone:813-381-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist