Provider Demographics
NPI:1053908434
Name:HENSON DEPASQUALE, LINDA CAROL (REV)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:HENSON DEPASQUALE
Suffix:
Gender:F
Credentials:REV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 MILL ST APT 602
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2639
Mailing Address - Country:US
Mailing Address - Phone:740-590-1213
Mailing Address - Fax:
Practice Address - Street 1:445 SEIGLE LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3326
Practice Address - Country:US
Practice Address - Phone:740-590-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor