Healthcare Provider Details

I. General information

NPI: 1083222491
Provider Name (Legal Business Name): MICHELE CAROLINE HENHAPL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 SKOKIE BLVD STE 426
NORTHBROOK IL
60062-4024
US

IV. Provider business mailing address

899 SKOKIE BLVD STE 426
NORTHBROOK IL
60062-4024
US

V. Phone/Fax

Practice location:
  • Phone: 312-481-8181
  • Fax:
Mailing address:
  • Phone: 312-481-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071010099
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: