Provider Demographics
NPI:1639722523
Name:MCHENRY, JEAN (CPM)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 PROSPECT PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1829
Mailing Address - Country:US
Mailing Address - Phone:630-877-7482
Mailing Address - Fax:
Practice Address - Street 1:107 PROSPECT PLACE DR
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1829
Practice Address - Country:US
Practice Address - Phone:630-877-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
18120013OtherNATIONAL ASSOCIATION REGISTERED MIDWIVES (NARM)