Provider Demographics
NPI:1578516027
Name:HENNING, NICOLE (AUD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HENNING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7845 OAKWOOD RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4280
Mailing Address - Country:US
Mailing Address - Phone:410-760-4327
Mailing Address - Fax:410-760-4328
Practice Address - Street 1:7845 OAKWOOD RD
Practice Address - Street 2:SUITE 303
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4280
Practice Address - Country:US
Practice Address - Phone:410-760-4327
Practice Address - Fax:410-760-4328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01059231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150LN0999Medicare ID - Type Unspecified