Provider Demographics
NPI:1659909281
Name:HENRY, OWIN S
Entity Type:Individual
Prefix:MR
First Name:OWIN
Middle Name:S
Last Name:HENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22417 STRASSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-5724
Mailing Address - Country:US
Mailing Address - Phone:312-296-5819
Mailing Address - Fax:
Practice Address - Street 1:22417 STRASSBURG AVE
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-5724
Practice Address - Country:US
Practice Address - Phone:312-296-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health