Healthcare Provider Details

I. General information

NPI: 1134086036
Provider Name (Legal Business Name): WILLIAM J HENSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N MAIN ST PO BOX 516
SANDOVAL IL
62882-1093
US

IV. Provider business mailing address

504 N MAIN ST
SANDOVAL IL
62882-1093
US

V. Phone/Fax

Practice location:
  • Phone: 618-267-8259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149026613
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: