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General NPI Number Information
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NPI Number | 1508149717
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Entity Type | Individual
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Provider Name | CONNIE LYNN HENKE S.L.P.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 156 ROUTE 302
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City | PINE BUSH
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State | NY
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Zip | 12566-7130
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Country | US
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Telephone | 845-744-2031
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 207
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City | GARDINER
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State | NY
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Zip | 12525-0207
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Country | US
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Telephone | 845-255-4990
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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 | 018843-1
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License Number State | NY
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