MEDICARE: ERIN NICOLE HENLEY MS CCC SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	LL60849522	WA

General Provider Information

NPI Number	:	1437790235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN NICOLE HENLEY MS CCC SLP

Provider Business Mailing Address
First Line	:	405 BELLEVUE AVE
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-1501
Country	:	US
Telephone Number	:	360-463-5598
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 CARRIAGE ST SW STE B
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-1049
Country	:	US
Telephone Number	:	360-358-5306
Fax Number	:	360-634-4312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2019
Last Update Date	:	09/25/2025

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