Provider Demographics
NPI:1962175588
Name:HENDERSON, DANETTE (HEARING SPECIALIST)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:HEARING SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2430
Mailing Address - Country:US
Mailing Address - Phone:309-736-2616
Mailing Address - Fax:309-736-2617
Practice Address - Street 1:3819 16TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7210
Practice Address - Country:US
Practice Address - Phone:309-736-2616
Practice Address - Fax:309-376-2617
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3211237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist