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General NPI Number Information
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NPI Number | 1891505616
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Entity Type | Individual
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Provider Name | HEATHER HENDERSON RN BSN IBCLC
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Gender | Female
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1621 W CARROLL AVE
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City | CHICAGO
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State | IL
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Zip | 60612-2501
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Country | US
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Telephone | 217-508-9082
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Fax |
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Provider Business Mailing Address
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Address Line | 839 SHERWOOD PL
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City | CHARLESTON
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State | IL
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Zip | 61920-1724
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Country | US
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Telephone | 217-508-9082
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | L-317510
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License Number State | IL
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