Provider Demographics
NPI:1154695526
Name:HENDERSON, LESLIE R (BBA, MBA)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:R
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BBA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 MANHATTAN BOULEVARD, HARVEY, LA 70058
Mailing Address - Street 2:SUITE 211 ROOM 6 & ROOM 7
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5328
Mailing Address - Country:US
Mailing Address - Phone:504-225-1202
Mailing Address - Fax:855-495-2118
Practice Address - Street 1:2516 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2151
Practice Address - Country:US
Practice Address - Phone:504-621-3211
Practice Address - Fax:855-495-2118
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator