Individual
KATHLEEN HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBSW
Contact information
Practice address
310 LA JARA ST, BLOOMFIELD, NM 87413-6626
(505) 634-3863
Mailing address
310 LA JARA ST, BLOOMFIELD, NM 87413-6626
(505) 634-3863
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
B-08513
NM
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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