Doctor Name: | MS. JENNIFER BETH HENDERSON |
NPI Number: | 1861594095 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA ATR LCPC |
License Number: | |
Business Practice Address: | 2235 S 10th Ave Broadview, IL - 601554027 |
Business Phone Number: | 7734052696 |
Business Fax Number: | 7083448605 |
Mailing Address: | 2235 S 10th Ave, BROADVIEW |
State: | IL |
Postal Code: | 601554027 |
Phone Number: | 7734052696 |
Fax Number: | 7083448605 |
NPI Enumeration Date: | 09/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |