Provider Demographics
NPI:1770102444
Name:HENDERSON, JENNIFER HARTWELL (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HARTWELL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-1418
Mailing Address - Country:US
Mailing Address - Phone:901-355-3876
Mailing Address - Fax:
Practice Address - Street 1:1535 VANN DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2095
Practice Address - Country:US
Practice Address - Phone:901-355-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist