Healthcare Provider Details

I. General information

NPI: 1891205449
Provider Name (Legal Business Name): AMY HENKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 UNIVERSITY BLVD
HAMILTON OH
45011-3315
US

IV. Provider business mailing address

1430 UNIVERSITY BLVD
HAMILTON OH
45011-3315
US

V. Phone/Fax

Practice location:
  • Phone: 513-896-3497
  • Fax:
Mailing address:
  • Phone: 513-896-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCDCIII.981080
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0005162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: