Jillian Hendricks, M.A. CCC-SLP

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

SL013360 Issued in PA

Practice address

2017 S Colorado St
Philadelphia, PA 19145-2911

Phone

(267) 664-9135

NPI assigned

Oct 9, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570579200000",
    "number": "1306488432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 S COLORADO ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452911",
            "telephone_number": "267-664-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 S COLORADO ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452911",
            "telephone_number": "267-664-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "JILLIAN",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-09",
        "last_updated": "2019-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "PA",
            "license": "SL013360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul L Henderson, BS
• Shelley Joyceanne Thomas Henderson, MD
• Shenise Nicole Henderson, LCSW
• Shonquell S Henderson
• Barry Hendler, MD DDS
• Summer Hendricks
• Hendrix Pharmacy Inc (Hendrix Pharmacy)
• Hendrix Vision Center Inc
• Ann Marie Hendrzak, MD
• Liam Heneghan, MD

• Early Intervention Provider Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Early Intervention Provider Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.