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General NPI Number Information
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NPI Number | 1467556589
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Entity Type | Individual
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Provider Name | KENNETH E HEINRICHS PSYD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 755 E. MCARDLE DRIVE SUITE E
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-1717
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Country | US
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Telephone | 815-342-7181
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Fax | 815-344-9795
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Provider Business Mailing Address
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Address Line | 755 E MCARDLE DR SUITE E
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-1717
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Country | US
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Telephone | 815-342-7181
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Fax | 815-344-9795
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006063
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2384057
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License Number State | WI
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