Provider Demographics
NPI:1972214104
Name:HENDRIX, TODD (HIS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 MALLORY LN STE 108
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2801
Mailing Address - Country:US
Mailing Address - Phone:615-771-8240
Mailing Address - Fax:
Practice Address - Street 1:2130 BROOKMEADE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4089
Practice Address - Country:US
Practice Address - Phone:931-490-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN919237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN919OtherSTATE OF TN