Provider Demographics
NPI:1447586367
Name:HENDERSON, LYNN M (MSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 OLD HENDERSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3623
Mailing Address - Country:US
Mailing Address - Phone:614-442-7650
Mailing Address - Fax:614-442-7656
Practice Address - Street 1:807 HAVENS CORNERS RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3114
Practice Address - Country:US
Practice Address - Phone:614-442-7650
Practice Address - Fax:614-442-7656
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 12002701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical