Provider Demographics
NPI:1477263036
Name:HENDRICKSEN, HANNA JEANETTE
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:JEANETTE
Last Name:HENDRICKSEN
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 1:239 JOLIE OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-7465
Mailing Address - Country:US
Mailing Address - Phone:309-558-4318
Mailing Address - Fax:
Practice Address - Street 1:507 SAINT MARY ST STE A
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2627
Practice Address - Country:US
Practice Address - Phone:985-387-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist