Lacey Dawn Hendrickson, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

DH61571364 Issued in WA

Practice address

700 SE 160TH Ave Ste 121
Vancouver, WA 98684-8910

Phone

(360) 253-3480

NPI assigned

Jul 31, 2024

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

State licenses

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

{
    "created_epoch": "1722384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1962231670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 SYLVAN WAY",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986329628",
            "telephone_number": "360-747-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SE 160TH AVE STE 121",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986848910",
            "telephone_number": "360-253-3480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "LACEY",
        "middle_name": "DAWN",
        "credential": "RDH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-31",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "WA",
            "license": "DH61571364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalli Hendricks, CCC-SLP
• Lance Hendricks
• McKenna Louise Hendricks
• Raejean Hendricks, CDPT
• Jordan Michelle Hendrickson, PSYD
• Scott G Henke
• Christina Hennelly, FNP-C, DNP
• Barbara Henriksen, OTR/L
• Samuel Robert Henrikson, DPT
• Andy Henriquez

• Dental Hygienist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Dental Hygienist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.