Provider Demographics
NPI:1225272362
Name:HENRICKSON, STEVEN P
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:HENRICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-1608
Mailing Address - Country:US
Mailing Address - Phone:715-743-5426
Mailing Address - Fax:608-785-5333
Practice Address - Street 1:1210 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1608
Practice Address - Country:US
Practice Address - Phone:715-743-5426
Practice Address - Fax:608-785-5333
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator