Provider Demographics
NPI:1861769812
Name:MCHENRY, MARIA DOROTHEA (SLPA)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DOROTHEA
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2553
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-2553
Mailing Address - Country:US
Mailing Address - Phone:928-660-9308
Mailing Address - Fax:
Practice Address - Street 1:141 AERO
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-2553
Practice Address - Country:US
Practice Address - Phone:928-660-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA75112355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant