MEDICARE: LYNN HENDERSON PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209024227	IL
2	367A00000X	Advanced Practice Midwife	209024227	IL

General Provider Information

NPI Number	:	1124782123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN HENDERSON PMHNP-BC

Provider Business Mailing Address
First Line	:	115 N PARKSIDE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3040
Country	:	US
Telephone Number	:	773-295-3060
Fax Number	:	773-295-3061

Provider Business Practice Location Address
First Line	:	115 N PARKSIDE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3040
Country	:	US
Telephone Number	:	773-295-3060
Fax Number	:	773-295-3061

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

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	02/13/2026

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