Provider Demographics
NPI:1245207703
Name:HENDERSON, LILLIAN WAY (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:WAY
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 KENBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5710
Mailing Address - Country:US
Mailing Address - Phone:919-469-9842
Mailing Address - Fax:
Practice Address - Street 1:1214 KENBRIDGE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5710
Practice Address - Country:US
Practice Address - Phone:919-469-9842
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4659235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist