Provider Information for 1104308105
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LAYLA IRENE HENDRICKS LSW
Sex: Female
NPI: 1104308105
Last Updated: 2018-09-05
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1104308105 | ||||||||
| Enumeration Date | 2018-09-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1331 12TH AVE STE 300 ALTOONA, PA 16601-3340 United States Phone: 814-934-4638 | Fax:814-201-2758 | ||||||||
| Primary Practice Address | 1331 12TH AVE STE 300 ALTOONA, PA 16601-3340 United States Phone: 814-934-4638 | Fax:814-201-2758 | ||||||||
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