Provider Demographics
NPI:1760074223
Name:LANGDON, HENRIETTE (EDD, H-CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:HENRIETTE
Middle Name:
Last Name:LANGDON
Suffix:
Gender:F
Credentials:EDD, H-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9267 HAVEN AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5449
Mailing Address - Country:US
Mailing Address - Phone:909-321-2012
Mailing Address - Fax:
Practice Address - Street 1:9267 HAVEN AVE STE 145
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5449
Practice Address - Country:US
Practice Address - Phone:909-321-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3625235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist