Provider Demographics
NPI:1427220797
Name:HENRY, ALYSON ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:ELIZABETH
Last Name:HENRY
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 1:111 N. WABASH AVE
Mailing Address - Street 2:SUITE 1021
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3133
Mailing Address - Country:US
Mailing Address - Phone:773-507-6868
Mailing Address - Fax:
Practice Address - Street 1:111 N. WABASH AVE
Practice Address - Street 2:SUITE 1021
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3133
Practice Address - Country:US
Practice Address - Phone:773-507-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical