Provider Demographics
NPI:1518079672
Name:HENRIKSEN, VIRGINIA (LISW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:HENRIKSEN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2411
Mailing Address - Country:US
Mailing Address - Phone:800-622-7285
Mailing Address - Fax:515-573-3130
Practice Address - Street 1:811 OAK ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1740
Practice Address - Country:US
Practice Address - Phone:402-880-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA057321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical