Provider Demographics
NPI:1639200561
Name:HENDRICKS, CATHRYN GRACE (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:GRACE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:CATHRYN
Other - Middle Name:GRACE
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:445 ROBIN CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2427
Mailing Address - Country:US
Mailing Address - Phone:203-671-4827
Mailing Address - Fax:
Practice Address - Street 1:445 ROBIN CT
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2427
Practice Address - Country:US
Practice Address - Phone:203-671-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003179235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003179OtherLICENSE #