Provider Demographics
NPI:1891800447
Name:HENNIGE, ERNEST E (MS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:E
Last Name:HENNIGE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:HENNIGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1200 EAST COLUMBIA
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114
Mailing Address - Country:US
Mailing Address - Phone:509-684-3701
Mailing Address - Fax:509-684-4180
Practice Address - Street 1:398 SOUTH MAIN
Practice Address - Street 2:TOWN CENTER BLDG SUITE 207
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114
Practice Address - Country:US
Practice Address - Phone:509-685-7834
Practice Address - Fax:509-685-2170
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004995101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8940562OtherL&I CRIME VICTIMS