Provider Demographics
NPI:1487752176
Name:HENDERSON, NICOLE D
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7038 TALLOW KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7845
Mailing Address - Country:US
Mailing Address - Phone:281-914-3100
Mailing Address - Fax:281-633-0899
Practice Address - Street 1:7038 TALLOW KNOLL LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-7845
Practice Address - Country:US
Practice Address - Phone:281-914-3100
Practice Address - Fax:281-633-0899
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0657199-01Medicaid