Provider Demographics
NPI:1578756466
Name:HENDERSON, ANDREA LEIGH (LM, CPM, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LM, CPM, IBCLC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LEIGH
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM, CPM, IBCLC
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-2045
Mailing Address - Country:US
Mailing Address - Phone:425-286-0466
Mailing Address - Fax:425-341-9661
Practice Address - Street 1:18208 66TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-7949
Practice Address - Country:US
Practice Address - Phone:425-286-0466
Practice Address - Fax:425-341-9661
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
WA174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN