Active NPI
Jenna E Hendricks
- Speech-Language Pathologist
- Albuquerque, NM
National Provider Identifier
1710100920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- C3980
- Practice address
- 4505 Bali CT NE
Albuquerque, NM 87111-2801 - Phone
- (505) 264-3102
- NPI assigned
- Apr 10, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | C3980 | NM | Primary |
Addresses
Primary practice location
4505 Bali CT NE
Albuquerque, NM 87111-2801
Mailing address
4505 Bali CT NE
Albuquerque, NM 87111-2801
Phone (505) 264-3102
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 |
|---|---|---|---|
| C3980 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710100920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4505 BALI CT NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871112801",
"telephone_number": "505-264-3102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4505 BALI CT NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871112801",
"telephone_number": "505-264-3102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKS",
"first_name": "JENNA",
"middle_name": "E",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NM",
"license": "C3980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.