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General NPI Number Information
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NPI Number | 1043573116
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Entity Type | Individual
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Provider Name | CHERYL ANITA HENDERSON M.A., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 655 KENMOOR AVE SE STE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8622
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Country | US
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Telephone | 616-575-1208
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Fax | 616-575-1219
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Provider Business Mailing Address
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Address Line | 655 KENMOOR AVE SE STE A
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8622
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Country | US
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Telephone | 616-575-1208
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Fax | 616-575-1219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 1601000158
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License Number State | MI
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