Active NPI
Jennifer Jean Henderson, L.M.T.
- Specialist
- Winslow, AR
National Provider Identifier
1104079219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 2176
- Practice address
- 341 Winslow Blvd
Winslow, AR 72959 - Phone
- (479) 841-2081
- Fax
- (479) 634-5109
- NPI assigned
- Nov 3, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 2176 | AR | Primary |
Addresses
Primary practice location
341 Winslow Blvd
Winslow, AR 72959
Mailing address
341 Winslow Blvd
Winslow, AR 72959
Phone (479) 841-2081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2176 | AR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225670400000",
"number": "1104079219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "341 WINSLOW BLVD",
"city": "WINSLOW",
"state": "AR",
"postal_code": "72959",
"telephone_number": "479-841-2081",
"fax_number": "479-634-5109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "341 WINSLOW BLVD",
"city": "WINSLOW",
"state": "AR",
"postal_code": "72959",
"telephone_number": "479-841-2081",
"fax_number": "479-634-5109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "JENNIFER",
"middle_name": "JEAN",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-03",
"last_updated": "2008-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AR",
"license": "2176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winslow, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.