Healthcare Provider Details

I. General information

NPI: 1831362839
Provider Name (Legal Business Name): LORETTA PEARLE HENSON PHD., LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORETTA PEARLE LONGSDORF PHD., LP

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W CASCADE AVE
RIVER FALLS WI
54022-2222
US

IV. Provider business mailing address

123 W CASCADE AVE
RIVER FALLS WI
54022-2222
US

V. Phone/Fax

Practice location:
  • Phone: 715-426-4967
  • Fax: 715-426-0985
Mailing address:
  • Phone: 715-426-4967
  • Fax: 715-426-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2135-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: