Provider Demographics
NPI:1134356595
Name:HENDERSHOT, CHRISTINE JEAN (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JEAN
Last Name:HENDERSHOT
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N. LOBB AVENUE
Mailing Address - Street 2:
Mailing Address - City:PEN ARGYL
Mailing Address - State:PA
Mailing Address - Zip Code:18072-1451
Mailing Address - Country:US
Mailing Address - Phone:610-863-0387
Mailing Address - Fax:
Practice Address - Street 1:214 N LOBB AVE
Practice Address - Street 2:
Practice Address - City:PEN ARGYL
Practice Address - State:PA
Practice Address - Zip Code:18072-1451
Practice Address - Country:US
Practice Address - Phone:610-863-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist