Provider Demographics
NPI:1396997359
Name:HENKE, KRISTIN NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:NICOLE
Last Name:HENKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E. NORMAL STREET
Mailing Address - Street 2:MCKINNEY BUILDING
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501
Mailing Address - Country:US
Mailing Address - Phone:660-785-4182
Mailing Address - Fax:660-785-4011
Practice Address - Street 1:100 E. NORMAL STREET
Practice Address - Street 2:MCKINNEY BUILDING
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:660-785-4182
Practice Address - Fax:660-785-4011
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023048026103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling