Provider Demographics
NPI:1134423551
Name:LJ HENDERSON
Entity type:Organization
Organization Name:LJ HENDERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:SLP ASSISTANT
Authorized Official - Phone:832-289-5663
Mailing Address - Street 1:11711 SHADOW CREEK PKWY
Mailing Address - Street 2:113
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7232
Mailing Address - Country:US
Mailing Address - Phone:713-534-3119
Mailing Address - Fax:713-436-3336
Practice Address - Street 1:11711 SHADOW CREEK PKWY
Practice Address - Street 2:113
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7232
Practice Address - Country:US
Practice Address - Phone:713-534-3119
Practice Address - Fax:713-436-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331532355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty