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General NPI Number Information
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NPI Number | 1356902183
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Entity Type | Individual
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Provider Name | AMY ELIZABETH HENDERSON SLP-CF
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 103 ROSEHILL DR
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-4843
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Country | US
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Telephone | 434-517-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 605 W CHAPEL HILL ST APT 662
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City | DURHAM
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State | NC
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Zip | 27701-2776
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Country | US
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Telephone | 704-516-2048
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2204000322
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License Number State | VA
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