Provider Demographics
NPI:1710007869
Name:MCHENRY, ALEISA
Entity Type:Individual
Prefix:
First Name:ALEISA
Middle Name:
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2530
Mailing Address - Country:US
Mailing Address - Phone:209-569-0373
Mailing Address - Fax:209-569-0663
Practice Address - Street 1:621 14TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2530
Practice Address - Country:US
Practice Address - Phone:209-569-0373
Practice Address - Fax:209-569-0663
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator