Provider Demographics
NPI:1841961596
Name:HENDRICK, LISA ROCHELLE (ND)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROCHELLE
Last Name:HENDRICK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1414
Mailing Address - Country:US
Mailing Address - Phone:406-250-9305
Mailing Address - Fax:
Practice Address - Street 1:180 LITHIA WAY STE 3
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1891
Practice Address - Country:US
Practice Address - Phone:541-201-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4412175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath