MEDICARE: CONSTANCE HENDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		MO

General Provider Information

NPI Number	:	1689910002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE HENDERSON

Provider Business Mailing Address
First Line	:	9000 OLD SANTA FE RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3913
Country	:	US
Telephone Number	:	816-316-7000
Fax Number	:	816-316-8236

Provider Business Practice Location Address
First Line	:	9000 OLD SANTA FE RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3913
Country	:	US
Telephone Number	:	816-316-7000
Fax Number	:	816-316-8236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	12/13/2012

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Directions to “ CONSTANCE HENDERSON ” Practice Location

Language	Start Address	Practice Location

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