Provider Demographics
NPI:1720815814
Name:HENSLEY, PAULINE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 MIMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6105
Mailing Address - Country:US
Mailing Address - Phone:601-213-7552
Mailing Address - Fax:601-213-7552
Practice Address - Street 1:146 TIMBER CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4396
Practice Address - Country:US
Practice Address - Phone:901-654-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist