Provider Demographics
NPI:1659508042
Name:HENSOLD, KATHERINE ANN (BA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANN
Last Name:HENSOLD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3634
Mailing Address - Country:US
Mailing Address - Phone:217-373-2428
Mailing Address - Fax:217-373-2445
Practice Address - Street 1:502 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3634
Practice Address - Country:US
Practice Address - Phone:217-373-2428
Practice Address - Fax:217-373-2445
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health