Provider Demographics
NPI:1922409085
Name:HENDERSON, ANN REID (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:REID
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 CURITIBA CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1454
Mailing Address - Country:US
Mailing Address - Phone:678-827-6727
Mailing Address - Fax:
Practice Address - Street 1:5301 PROVIDENCE RD
Practice Address - Street 2:SUITE 80
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4128
Practice Address - Country:US
Practice Address - Phone:757-467-1900
Practice Address - Fax:757-467-7900
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007577235Z00000X
GASLP010740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist