MEDICARE: ANDREA HENDRICKS PH.D

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	103TC0700X	Clinical Psychologist	1763	AL

General Provider Information

NPI Number	:	1700216199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA HENDRICKS PH.D

Provider Business Mailing Address
First Line	:	402 OFFICE PARK DR
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2417
Country	:	US
Telephone Number	:	205-202-1428
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 OFFICE PARK DR
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2417
Country	:	US
Telephone Number	:	205-202-1428
Fax Number	:

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

Provider Enumeration Date	:	11/21/2013
Last Update Date	:	11/21/2013

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