Active NPI
Scott Robert Hendrickson, PHD
- Psychologist
- Tempe, AZ
National Provider Identifier
1194893453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 962
- Practice address
- 6625 S Rural Rd Ste 111
Tempe, AZ 85283-3717 - Phone
- (480) 345-9888
- Fax
- (480) 345-2126
- NPI assigned
- Dec 2, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 962 | AZ | Primary |
Addresses
Primary practice location
6625 S Rural Rd Ste 111
Tempe, AZ 85283-3717
Mailing address
6625 S Rural Rd Ste 111
Tempe, AZ 85283-3717
Phone (480) 345-9888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0135130 | Other | AZ | BLUECROSSBLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Previously, effective Oct 1, 2018 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 962 | AZ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194893453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6625 S RURAL RD STE 111",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852833717",
"telephone_number": "480-345-9888",
"fax_number": "480-345-2126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6625 S RURAL RD STE 111",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852833717",
"telephone_number": "480-345-9888",
"fax_number": "480-345-2126"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKSON",
"first_name": "SCOTT",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": "962",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "0135130",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.