| Doctor Name: | SHELLY MARIE HENDERSON |
| NPI Number: | 1396040077 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RMA |
| License Number: | 249694 |
| Business Practice Address: | 5612 E Cargill Ln Colbert, WA - 990059110 |
| Business Phone Number: | 5092384171 |
| Business Fax Number: | |
| Mailing Address: | 5021 E Cargill Ln, COLBERT |
| State: | WA |
| Postal Code: | 990059142 |
| Phone Number: | 5092384171 |
| Fax Number: | |
| NPI Enumeration Date: | 01/11/2011 |
| NPI Last Update Date: | 01/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320700000X |
| License Number: | 249694 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |