Provider Demographics
NPI:1265673081
Name:HENDERSON, JILL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442 BOX 268
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042-0268
Mailing Address - Country:US
Mailing Address - Phone:01609-230-8874
Mailing Address - Fax:314-371-2456
Practice Address - Street 1:CMR 442 BOX 268
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09042-0268
Practice Address - Country:US
Practice Address - Phone:01609-230-8874
Practice Address - Fax:314-371-2456
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490120011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical