Provider Demographics
NPI:1720247893
Name:HENDERSON, PATRICIA CALLAHAN (CCC-AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CALLAHAN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:CCC-AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 TIMOTHY DR
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1144
Mailing Address - Country:US
Mailing Address - Phone:508-584-5347
Mailing Address - Fax:
Practice Address - Street 1:300 HANOVER ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5444
Practice Address - Country:US
Practice Address - Phone:508-679-7709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist