Provider Demographics
NPI:1588803035
Name:HENDERSON MITCHELL, CLOTEE H
Entity Type:Individual
Prefix:MRS
First Name:CLOTEE
Middle Name:H
Last Name:HENDERSON MITCHELL
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 1:14623 HAWTHORNE BLVD
Mailing Address - Street 2:400
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1581
Mailing Address - Country:US
Mailing Address - Phone:310-970-5015
Mailing Address - Fax:310-263-2653
Practice Address - Street 1:14623 HAWTHORNE BLVD
Practice Address - Street 2:400
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1581
Practice Address - Country:US
Practice Address - Phone:310-970-5015
Practice Address - Fax:310-263-2653
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner