Provider Demographics
NPI:1801999271
Name:HENRY, ROBERT JAMES JR (AUD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:HENRY
Suffix:JR
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2085
Mailing Address - Street 2:214 E ELM AVE STE 111
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-7085
Mailing Address - Country:US
Mailing Address - Phone:734-241-4080
Mailing Address - Fax:734-241-4798
Practice Address - Street 1:214 E ELM AVE
Practice Address - Street 2:STE 111
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2678
Practice Address - Country:US
Practice Address - Phone:734-241-4080
Practice Address - Fax:734-241-4798
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000159231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9350768OtherPHCS
MI2867OtherHEALTH PLAN OF MI
MI3328905Medicaid
4500070OtherUNITED HEALTHCARE
MI540E802730OtherBCBS
MI640E826020OtherBCBS
MIRH989087OtherFEP
5898083OtherAETNA
MI3328905Medicaid
R75748Medicare UPIN