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General NPI Number Information
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NPI Number | 1194230284
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Entity Type | Individual
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Provider Name | MARY PATRICIA HENKE
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Gender | Female
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 850 HIGHLAND GROVE DR
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1549
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Country | US
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Telephone | 847-955-3621
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Fax | 847-215-3268
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Provider Business Mailing Address
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Address Line | 2514 W SPRUCE DR
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City | ROUND LAKE
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State | IL
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Zip | 60073-5255
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Country | US
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Telephone | 847-732-4588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.002046
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License Number State | IL
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