Individual
NICOLE DELORES HENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9310 NW 59TH TER, PARKVILLE, MO 64152-3536
(913) 909-5205
Mailing address
9310 NW 59TH TER, PARKVILLE, MO 64152-3536
(913) 909-5205
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/05/2011
Last updated
08/05/2015
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