MEDICARE: MARY PATRICIA HENKE

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	235Z00000X	Speech-Language Pathologist	146.002046	IL

General Provider Information

NPI Number	:	1194230284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY PATRICIA HENKE

Provider Business Mailing Address
First Line	:	2514 W SPRUCE DR
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-5255
Country	:	US
Telephone Number	:	847-732-4588
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 HIGHLAND GROVE DR
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1549
Country	:	US
Telephone Number	:	847-955-3621
Fax Number	:	847-215-3268

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	12/11/2017

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Directions to “ MARY PATRICIA HENKE ” Practice Location

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