Shannon Leah Hendrickson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

4779 Issued in AZ

Practice address

15411 W Waddell Rd, Ste 102
#1096
Surprise, AZ 85379

Phone

(602) 492-2995

Fax

(623) 288-8017

NPI assigned

Nov 15, 2016

Last updated

Aug 25, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Opted out of Medicare

Yes, effective Apr 1, 2026 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Juniper Path Psychology

  • Clinical Psychologist
  • Scottsdale, AZ
  • NPI 1811708191
  NPD Authorized official
• Tucson Counseling Associates, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tucson, AZ
  • NPI 1013545144
  NPD (past)

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

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756080000000",
    "number": "1629510169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15411 W WADDELL RD, STE 102",
            "address_2": "#1096",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "85379",
            "telephone_number": "602-492-2995",
            "fax_number": "623-288-8017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15411 W WADDELL RD, STE 102",
            "address_2": "#1096",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "85379",
            "telephone_number": "602-492-2995",
            "fax_number": "623-288-8017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "SHANNON",
        "middle_name": "LEAH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-15",
        "last_updated": "2025-08-25",
        "certification_date": "2025-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "4779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanne Marie Helling
• Helping Hands Assisted Living
• Helping Hands Group Home LLC
• Katrina Hembree, LPC
• Edyth Z Hendricks, P.A.
• Mikelle Rae Henrichsen
• Vanessa Lynn Henry, RN, IBCLC, RNFA
• Sonia Hercules
• Vickie Hereau
• Olivia Hermans

• Clinical Psychologist in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Clinical Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.