Provider Demographics
NPI:1659542843
Name:HENDERSON, CHRISTI M
Entity Type:Individual
Prefix:MS
First Name:CHRISTI
Middle Name:M
Last Name:HENDERSON
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 1:908 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5722
Mailing Address - Country:US
Mailing Address - Phone:605-367-4293
Mailing Address - Fax:605-367-5714
Practice Address - Street 1:908 N WEST AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5722
Practice Address - Country:US
Practice Address - Phone:605-367-4293
Practice Address - Fax:605-367-5714
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5180100Medicaid