Individual
BURGANDY D HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14792 CATLIN TILTON RD, DANVILLE, IL 61834-5116
(217) 443-6430
Mailing address
213 E CONRON AVE, DANVILLE, IL 61832-1805
(217) 737-4331
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.014592
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146.014592
STATE LICENSE
IL
Enumeration date
06/05/2020
Last updated
06/05/2020
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