Provider Demographics
NPI:1790665339
Name:HENDERSON, ALLISON A
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:A
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 STATE ROUTE 179
Mailing Address - Street 2:
Mailing Address - City:JEROMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44840-9798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2157 STATE ROUTE 179
Practice Address - Street 2:
Practice Address - City:JEROMESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44840-9798
Practice Address - Country:US
Practice Address - Phone:419-577-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant