Provider Demographics
NPI:1265078190
Name:HENSON, ERIN (SLP CF)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HENSON
Suffix:
Gender:F
Credentials:SLP CF
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 92
Mailing Address - Street 2:
Mailing Address - City:SPANGLE
Mailing Address - State:WA
Mailing Address - Zip Code:99031-0092
Mailing Address - Country:US
Mailing Address - Phone:509-362-2464
Mailing Address - Fax:
Practice Address - Street 1:215 E SPOKANE AVE
Practice Address - Street 2:
Practice Address - City:REARDAN
Practice Address - State:WA
Practice Address - Zip Code:99029-8628
Practice Address - Country:US
Practice Address - Phone:509-796-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61001000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist