Provider Demographics
NPI:1821724402
Name:HENDERSON, JENNIFER NADINE (MT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NADINE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 W AMHERST AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3436
Mailing Address - Country:US
Mailing Address - Phone:816-316-0614
Mailing Address - Fax:
Practice Address - Street 1:2828 N SPEER BLVD UNIT 117
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4215
Practice Address - Country:US
Practice Address - Phone:720-401-5728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0012321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist