Provider Demographics
NPI:1114445293
Name:HENCEROTH, CINDY SUZANNE (LSW, ATR/BC)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:SUZANNE
Last Name:HENCEROTH
Suffix:
Gender:F
Credentials:LSW, ATR/BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N SUNDALE RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:OH
Mailing Address - Zip Code:43767-9766
Mailing Address - Country:US
Mailing Address - Phone:740-319-9665
Mailing Address - Fax:
Practice Address - Street 1:2540 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1990
Practice Address - Country:US
Practice Address - Phone:614-602-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0177733171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH171M00000XMedicaid
OH171M000000XMedicaid