MEDICARE: JAVONNI HENDERSON

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	104100000X	Social Worker		NV
2	104100000X	Social Worker	121724	CA
3	1041C0700X	Clinical Social Worker	112512	TX
4	1041C0700X	Clinical Social Worker	121724	CA
5	1041C0700X	Clinical Social Worker		NV
6	171M00000X	Case Manager/Care Coordinator
7	1041C0700X	Clinical Social Worker	09929237	CO

General Provider Information

NPI Number	:	1861675548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVONNI HENDERSON

Provider Business Mailing Address
First Line	:	18121 E HAMPDEN AVE STE C1079
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-3590
Country	:	US
Telephone Number	:	510-256-9794
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 S BLACKHAWK ST STE 240
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-1475
Country	:	US
Telephone Number	:	510-256-9794
Fax Number	:

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

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	11/20/2024

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Directions to “ JAVONNI HENDERSON ” Practice Location

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