Provider Demographics
NPI:1942629191
Name:HENLEY-FLEMING, GWENDOLYN SUE (CLC)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:SUE
Last Name:HENLEY-FLEMING
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-0413
Mailing Address - Country:US
Mailing Address - Phone:901-351-9815
Mailing Address - Fax:901-465-7821
Practice Address - Street 1:20 OAKLEAF CV
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-3251
Practice Address - Country:US
Practice Address - Phone:901-351-9815
Practice Address - Fax:901-465-7821
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNALPP-202753174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN