Provider Demographics
NPI:1073899340
Name:HENDERSON, VALERIE (PHD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GISHOLT DR
Mailing Address - Street 2:STE 209
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4835
Mailing Address - Country:US
Mailing Address - Phone:414-202-9146
Mailing Address - Fax:
Practice Address - Street 1:6400 GISHOLT DR
Practice Address - Street 2:STE 209
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4835
Practice Address - Country:US
Practice Address - Phone:414-202-9146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 103TA0400X, 101YM0800X, 103TP2701X, 101Y00000X
WI3167-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No101Y00000XBehavioral Health & Social Service ProvidersCounselor