Jack K Henderson, MS - CCC -SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0000005678 Issued in TN

Practice address

2200 21St Ave S Ste 409
Nashville, TN 37212-4929

Phone

(615) 669-2547

NPI assigned

Apr 22, 2019

Sex

Male

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• Henderson Stuttering Therapy PLLC

  • Speech-Language Pathologist
  • Nashville, TN
  • NPI 1609647734
  NPD Authorized official

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1821651241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 21ST AVE S STE 409",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372124929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 21ST AVE S STE 409",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372124929",
            "telephone_number": "615-669-2547"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 The Vanderbilt Clinic",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320014",
            "country_code": "US",
            "telephone_number": "615-936-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1215 21st Ave S Ste 6209",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320014",
            "country_code": "US",
            "telephone_number": "615-875-7671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JACK",
        "middle_name": "K",
        "credential": "MS - CCC -SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-22",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TN",
            "license": "0000005678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley L Henderson, BCBA, LBA
• Beverly Henderson
• Carmen Henderson
• Christopher Henderson, MD
• Eric Bruce Henderson II, PT, DPT
• Jim P. Henderson, MD
• Katelyn Henderson, MD
• Lisa Danielle Henderson, B.S., M.S., M.A.
• Mary Pullias Henderson, FNP-BC
• Melinda Shaw Henderson, M.D.

• Speech-Language Pathologist in Nashville, TN
• Providers in Nashville, TN by specialty
• Speech-Language Pathologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; 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.