MEDICARE: MS. DENISE VERNER HENDERSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2632	OK

General Provider Information

NPI Number	:	1124109285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE VERNER HENDERSON LCSW

Provider Business Mailing Address
First Line	:	7108 NW WOODLAND CIR
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5431
Country	:	US
Telephone Number	:	580-536-2405
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 MOW-WAY RD
Second Line	:
City	:	FT. SILL
State	:	OK
Zip	:	73503-6300
Country	:	US
Telephone Number	:	580-442-6069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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