Provider Demographics
NPI:1053688564
Name:HENSLEY, AUDREY JO
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:JO
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ARGONNE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-1063
Mailing Address - Country:US
Mailing Address - Phone:309-825-2190
Mailing Address - Fax:
Practice Address - Street 1:165 ARGONNE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-1063
Practice Address - Country:US
Practice Address - Phone:309-825-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist