Provider Demographics
NPI:1659036960
Name:HENKELMAN, CHAD EDWIN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:EDWIN
Last Name:HENKELMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3646
Mailing Address - Country:US
Mailing Address - Phone:316-651-1222
Mailing Address - Fax:
Practice Address - Street 1:555 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3646
Practice Address - Country:US
Practice Address - Phone:316-651-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12417104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker