Provider Demographics
NPI:1417657248
Name:HENSLEY, STEPHANIE ANNE
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANNE
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 1:1620 SANTA CLARA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3559
Mailing Address - Country:US
Mailing Address - Phone:916-786-3750
Mailing Address - Fax:916-786-3761
Practice Address - Street 1:1620 SANTA CLARA DR STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3559
Practice Address - Country:US
Practice Address - Phone:916-786-3750
Practice Address - Fax:916-786-3761
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-LFTQKR172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker