Provider Demographics
NPI:1912441346
Name:HENRIQUEZ, ALEJANDRINA
Entity Type:Individual
Prefix:
First Name:ALEJANDRINA
Middle Name:
Last Name:HENRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEJANDRINA
Other - Middle Name:
Other - Last Name:HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3916D FORSYTH CT
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE MDL
Mailing Address - State:NJ
Mailing Address - Zip Code:08641-1668
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3916D FORSYTH CT
Practice Address - Street 2:
Practice Address - City:JOINT BASE MDL
Practice Address - State:NJ
Practice Address - Zip Code:08641-1668
Practice Address - Country:US
Practice Address - Phone:520-232-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00639500235Z00000X
PASL013108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist