=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083818819
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA W HENDRICKSON M.S. CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 MARSHALL ST KIDS FIRST POC
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72202-3510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-364-3614
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 486 SWEETWATER LN
-----------------------------------------------------
City | WARD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72176-9271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-843-2116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 507
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------