Provider Demographics
NPI:1669530317
Name:HENSCHEN, THOMAS L (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:HENSCHEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 E HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3660
Mailing Address - Country:US
Mailing Address - Phone:630-933-8895
Mailing Address - Fax:
Practice Address - Street 1:1375 E SCHAUMBURG RD
Practice Address - Street 2:STE 260
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-5166
Practice Address - Country:US
Practice Address - Phone:847-895-4540
Practice Address - Fax:847-895-4544
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL359600Medicare ID - Type Unspecified