Provider Demographics
NPI:1831806074
Name:HENDERSON, MARLEE KAY (SLP)
Entity type:Individual
Prefix:
First Name:MARLEE
Middle Name:KAY
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-3506
Mailing Address - Country:US
Mailing Address - Phone:512-983-8358
Mailing Address - Fax:
Practice Address - Street 1:1226 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-3506
Practice Address - Country:US
Practice Address - Phone:512-983-8358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSLP.0003894OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
14361881OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION