Individual
SHELLY MARIE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RMA
Contact information
Practice address
5612 E CARGILL LN, COLBERT, WA 99005-9110
(509) 238-4171
Mailing address
5021 E CARGILL LN, COLBERT, WA 99005-9142
(509) 238-4171
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
249694
WA
Other
Enumeration date
01/11/2011
Last updated
01/11/2011
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