MEDICARE: JENNIFER L HENRY MSW, CSAC, ICS, CSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952590556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L HENRY MSW, CSAC, ICS, CSW

Provider Business Mailing Address
First Line	:	1314 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2114
Country	:	US
Telephone Number	:	414-727-7985
Fax Number	:	414-727-8121

Provider Business Practice Location Address
First Line	:	1314 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2114
Country	:	US
Telephone Number	:	414-727-7985
Fax Number	:	414-727-8121

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	02/11/2009

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