Provider Demographics
NPI:1770718306
Name:HENDERSON, CLAYTON EUGENE (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:EUGENE
Last Name:HENDERSON
Suffix:
Gender:M
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 1:219 REDFIELD DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-1731
Mailing Address - Country:US
Mailing Address - Phone:724-307-3367
Mailing Address - Fax:
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:304-797-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist