Provider Demographics
NPI:1952590556
Name:HENRY, JENNIFER L (MSW, CSAC, ICS, CSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HENRY
Suffix:
Gender:F
Credentials:MSW, CSAC, ICS, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2114
Mailing Address - Country:US
Mailing Address - Phone:414-727-7985
Mailing Address - Fax:414-727-8121
Practice Address - Street 1:1314 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2114
Practice Address - Country:US
Practice Address - Phone:414-727-7985
Practice Address - Fax:414-727-8121
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39179200Medicaid