Provider Demographics
NPI:1639640493
Name:HENSLEY, KRISANNE LENORE (CDP)
Entity type:Individual
Prefix:
First Name:KRISANNE
Middle Name:LENORE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 W SPOFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4354
Mailing Address - Country:US
Mailing Address - Phone:509-362-7182
Mailing Address - Fax:509-326-3370
Practice Address - Street 1:3400 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2119
Practice Address - Country:US
Practice Address - Phone:509-325-2355
Practice Address - Fax:509-326-3370
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60728501101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty