MEDICARE: DR. ALICE HENSLEY PH.D.

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	103TS0200X	School Psychologist	1551866	IN

General Provider Information

NPI Number	:	1871310334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE HENSLEY PH.D.

Provider Business Mailing Address
First Line	:	8926 WOODSTREAM DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6568
Country	:	US
Telephone Number	:	260-579-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	4814 HOMESTEAD RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-5461
Country	:	US
Telephone Number	:	260-431-0528
Fax Number	:

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

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	09/25/2024

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