Provider Demographics
NPI:1790504272
Name:HENDRICKSON, LANNY
Entity type:Individual
Prefix:
First Name:LANNY
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23178 W WALL LAKE BND
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-8296
Mailing Address - Country:US
Mailing Address - Phone:218-205-0382
Mailing Address - Fax:
Practice Address - Street 1:1164 FRIBERG AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1580
Practice Address - Country:US
Practice Address - Phone:218-739-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator