Provider Demographics
NPI:1316557275
Name:HENDERSON, JENNIFER RAE (MS, ED CF-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, ED CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 ROAD 1625
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:NE
Mailing Address - Zip Code:68930-7700
Mailing Address - Country:US
Mailing Address - Phone:402-469-2799
Mailing Address - Fax:
Practice Address - Street 1:606 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:NE
Practice Address - Zip Code:68930-3535
Practice Address - Country:US
Practice Address - Phone:402-756-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist