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General NPI Number Information
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NPI Number | 1649915349
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Entity Type | Individual
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Provider Name | FREDERICK J HENKEN
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Gender | Male
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 8803 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-3347
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Country | US
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Telephone | 239-272-0838
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Fax |
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Provider Business Mailing Address
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Address Line | 4785 SHINNECOCK HILLS CT APT 201
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City | NAPLES
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State | FL
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Zip | 34112-7976
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Country | US
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Telephone | 239-919-4952
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-213440
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License Number State | FL
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