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NPI Code Detail

MEDICARE: DR. JENNE HENDERSON PHD

MEDICARE: DR. JENNE HENDERSON PHD
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
1103TC2200XClinical Child & Adolescent Psychologist1046OR

General Provider Information

NPI Number : 1972726206
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNE HENDERSON PHD
Provider Business Mailing Address
First Line : 7707 SW CAPITOL HWY
Second Line :
City : PORTLAND
State : OR
Zip : 97219-2458
Country : US
Telephone Number : 503-452-8002
Fax Number : 503-452-0084
Provider Business Practice Location Address
First Line : 7707 SW CAPITOL HWY
Second Line :
City : PORTLAND
State : OR
Zip : 97219-2458
Country : US
Telephone Number : 503-452-8002
Fax Number : 503-452-0084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2007
Last Update Date : 07/08/2007

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