Provider Demographics
NPI:1437790235
Name:HENLEY, ERIN NICOLE (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:HENLEY
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 1:405 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-1501
Mailing Address - Country:US
Mailing Address - Phone:360-463-5598
Mailing Address - Fax:
Practice Address - Street 1:2413 PACIFIC AVE SE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2087
Practice Address - Country:US
Practice Address - Phone:360-358-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60849522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist