Provider Demographics
NPI:1326478538
Name:HENDERSON, LORA
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
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 1:758 S 1ST ST
Mailing Address - Street 2:CENTER ONE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2023
Mailing Address - Country:US
Mailing Address - Phone:502-589-8959
Mailing Address - Fax:502-589-8949
Practice Address - Street 1:758 S 1ST ST
Practice Address - Street 2:CENTER ONE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2023
Practice Address - Country:US
Practice Address - Phone:502-589-8959
Practice Address - Fax:502-589-8949
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator