Healthcare Provider Details

I. General information

NPI: 1174058564
Provider Name (Legal Business Name): JOI HENRY DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 03/07/2023
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 424
CHICAGO IL
60602-3844
US

IV. Provider business mailing address

1506 E ROOSEVELT RD
WHEATON IL
60187-6806
US

V. Phone/Fax

Practice location:
  • Phone: 312-279-9981
  • Fax: 312-279-9981
Mailing address:
  • Phone: 630-221-1400
  • Fax: 630-221-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.024578
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number309.018490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: