Healthcare Provider Details

I. General information

NPI: 1770830002
Provider Name (Legal Business Name): SARAH ANNE HENDERSON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N GARRISON RD
VANCOUVER WA
98664-1313
US

IV. Provider business mailing address

1015 N GARRISON RD
VANCOUVER WA
98664-1313
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-7501
  • Fax:
Mailing address:
  • Phone: 360-694-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13648
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9927
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number60318904
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: