Provider Demographics
NPI:1902493505
Name:HENDRICKSON, KATELYN JEAN
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:JEAN
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:JEAN
Other - Last Name:ALBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31557 SCHOOLCRAFT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1848
Mailing Address - Country:US
Mailing Address - Phone:734-474-2958
Mailing Address - Fax:
Practice Address - Street 1:7016 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-4300
Practice Address - Country:US
Practice Address - Phone:937-951-2084
Practice Address - Fax:877-739-5359
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-22-199988106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician