Provider Demographics
NPI:1790007599
Name:HENDERLITE, PATRICIA BOONE
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:BOONE
Last Name:HENDERLITE
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 1:11535 CARMEL COMMONS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5313
Mailing Address - Country:US
Mailing Address - Phone:704-541-3737
Mailing Address - Fax:704-540-9199
Practice Address - Street 1:11535 CARMEL COMMONS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5313
Practice Address - Country:US
Practice Address - Phone:704-541-3737
Practice Address - Fax:704-540-9199
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist