Provider Demographics
NPI:1861535056
Name:HENDRIX, DEIRDRE R (M ED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:R
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 HOE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2482
Mailing Address - Country:US
Mailing Address - Phone:919-606-4559
Mailing Address - Fax:910-875-7647
Practice Address - Street 1:4612 HOE CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2482
Practice Address - Country:US
Practice Address - Phone:919-606-4559
Practice Address - Fax:910-565-3676
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7444588Medicaid