Healthcare Provider Details

I. General information

NPI: 1487761094
Provider Name (Legal Business Name): BARBARA K HENRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 FREMONT ST
KIEL WI
53042-1423
US

IV. Provider business mailing address

PO BOX 305
KIEL WI
53042-0305
US

V. Phone/Fax

Practice location:
  • Phone: 920-894-7900
  • Fax: 920-894-7900
Mailing address:
  • Phone: 920-894-7900
  • Fax: 920-894-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number506-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: