Provider Demographics
NPI:1326364126
Name:HENSON, LORI DENISE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:DENISE
Last Name:HENSON
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 CROSS TIMBERS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-8220
Mailing Address - Country:US
Mailing Address - Phone:918-706-1375
Mailing Address - Fax:918-224-2376
Practice Address - Street 1:4870 S LEWIS AVE
Practice Address - Street 2:SUITE 242
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-5151
Practice Address - Country:US
Practice Address - Phone:918-706-1375
Practice Address - Fax:918-224-2376
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist