Doctor Name: | HEIDI JO HENDRICKSON |
NPI Number: | 1770923187 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LAT, ATC |
License Number: | AT5588 |
Business Practice Address: | 6200 College Ave Snyder, TX - 795496105 |
Business Phone Number: | 5094313338 |
Business Fax Number: | |
Mailing Address: | 1503 S James Ave, MOSES LAKE |
State: | WA |
Postal Code: | 988372151 |
Phone Number: | 5094313338 |
Fax Number: | |
NPI Enumeration Date: | 06/28/2013 |
NPI Last Update Date: | 06/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | AT5588 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |