Provider Demographics
NPI:1215347380
Name:HENDRICKS, MONICA L (PSS, WRAP)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:L
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:PSS, WRAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 HOMER ROAD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055
Mailing Address - Country:US
Mailing Address - Phone:318-371-3001
Mailing Address - Fax:318-371-3300
Practice Address - Street 1:435 HOMER ROAD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055
Practice Address - Country:US
Practice Address - Phone:318-371-3001
Practice Address - Fax:318-371-3300
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11558175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist