Provider Demographics
NPI:1982490231
Name:HENDERSON, JAYDEN (LMT)
Entity type:Individual
Prefix:
First Name:JAYDEN
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3738 SOLUTION CENTER LOCKBOX #773738
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:859-251-3402
Mailing Address - Fax:502-867-0560
Practice Address - Street 1:108 OSBORNE WAY STE 6
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9693
Practice Address - Country:US
Practice Address - Phone:859-251-3402
Practice Address - Fax:502-867-0560
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY294970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist