Provider Demographics
NPI:1366573883
Name:HENDRIX, MARCY GRANT
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:GRANT
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARCY
Other - Middle Name:LYNN
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10336 VISTA PINES LOOP
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9172
Mailing Address - Country:US
Mailing Address - Phone:352-461-3431
Mailing Address - Fax:
Practice Address - Street 1:2760 DORA AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4970
Practice Address - Country:US
Practice Address - Phone:352-742-7837
Practice Address - Fax:352-508-5113
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892048500Medicaid