Provider Demographics
NPI:1548742240
Name:HENRY HEARING CLINIC, LLC
Entity Type:Organization
Organization Name:HENRY HEARING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:JUMPER
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:501-944-8798
Mailing Address - Street 1:3850 SERENITY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6521
Mailing Address - Country:US
Mailing Address - Phone:501-944-8798
Mailing Address - Fax:
Practice Address - Street 1:23251 INTERSTATE 30 S
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2571
Practice Address - Country:US
Practice Address - Phone:501-944-8798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA419231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA