Provider Demographics
NPI:1497141048
Name:HENNIG, CHERYL L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:HENNIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JUNCTION DR W STE 3
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-2931
Mailing Address - Country:US
Mailing Address - Phone:618-972-1598
Mailing Address - Fax:
Practice Address - Street 1:9 JUNCTION DR W
Practice Address - Street 2:SUITE 3
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-2931
Practice Address - Country:US
Practice Address - Phone:618-972-1568
Practice Address - Fax:618-654-8231
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004745103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical