Henderson, Randall Wayne

Henderson, Randall Wayne is an individual health care provider with primary practice located at 10404 W Coggins Dr Suite 110, Sun City AZ 85351-3437. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Speech, Language and Hearing Service Providers / Hearing Instrument Specialist. Speech, Language and Hearing Service Providers / Hearing Instrument Specialist is his primary health care specialty. Henderson, Randall Wayne can be contacted via phone (623) 974-9666.

Contact Information

Primary practice address
10404 W Coggins Dr Suite 110 Sun City AZ 85351-3437
Phone: (623) 974-9666
Fax: (623) 974-4813
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 00729 Iowa
Speech, Language and Hearing Service Providers / Hearing Instrument Specialist 237700000X

Profile Details

NPI number 1043334261
LBN Legal business name Henderson, Randall Wayne
Credentials BC-HIS
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2007
Last updated Jul 18th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043334261 NPPES
Iowa MEDICAID 0227132
Iowa MEDICAID 42150911900
Iowa Other 348031700

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