Provider Demographics
NPI:1679644207
Name:HENDRICKS-BACON, HOPE (SLP)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:
Last Name:HENDRICKS-BACON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4367
Mailing Address - Country:US
Mailing Address - Phone:626-793-4129
Mailing Address - Fax:626-585-8261
Practice Address - Street 1:540 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4367
Practice Address - Country:US
Practice Address - Phone:626-793-4129
Practice Address - Fax:626-585-8261
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist