Provider Demographics
NPI:1629510169
Name:HENDRICKSON, SHANNON LEAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEAH
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 W WADDELL RD, STE 102
Mailing Address - Street 2:#1096
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379
Mailing Address - Country:US
Mailing Address - Phone:602-492-2995
Mailing Address - Fax:623-288-8017
Practice Address - Street 1:15411 W WADDELL RD, STE 102
Practice Address - Street 2:#1096
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379
Practice Address - Country:US
Practice Address - Phone:602-492-2995
Practice Address - Fax:623-288-8017
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4779103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical