Healthcare Provider Details

I. General information

NPI: 1366215477
Provider Name (Legal Business Name): RILEY MAE HENDERSON LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E VERITY ST
THE PLAINS OH
45780-1533
US

IV. Provider business mailing address

11 E VERITY ST
THE PLAINS OH
45780-1533
US

V. Phone/Fax

Practice location:
  • Phone: 501-442-1597
  • Fax:
Mailing address:
  • Phone: 501-442-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2608239
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: