Provider Demographics
NPI:1518071778
Name:HENDERSON, JUDITH ANN (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:JUDE
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED PSYCHOLOGIS
Mailing Address - Street 1:3710 SOUTH KIWANIS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-373-9066
Mailing Address - Fax:605-373-9145
Practice Address - Street 1:3710 SOUTH KIWANIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-373-9066
Practice Address - Fax:605-373-9145
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD372103T00000X
SDR010634163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
106137OtherCHOICE PLUS
HP29926OtherHEALTH PARTNERS
3052OtherAVERA HEALTH PLANS
SD6551272Medicaid
7878OtherMIDLANDS CHOICE
86734OtherHEALTH PARTNERS
SD22053OtherSIOUX VALLEY HEALTH PLAN
0040725OtherBLUE CROSS BLUE SHIELD
SD22053OtherSIOUX VALLEY HEALTH PLAN