Provider Demographics
NPI:1295309581
Name:HENRY, MIRIAM R (MS, CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:R
Last Name:HENRY
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:MISS
Other - First Name:MIRIAM
Other - Middle Name:R
Other - Last Name:ARSENAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 MILK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3052
Mailing Address - Country:US
Mailing Address - Phone:603-915-0290
Mailing Address - Fax:
Practice Address - Street 1:37 BLANCHARD ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-4350
Practice Address - Country:US
Practice Address - Phone:603-966-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-0842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist