Physician Compare National (NPI:1558714741)

HEALTHCARE PROVIDER: CORBIN HENNINGSEN LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1558714741
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7517209273
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190429001224
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HENNINGSEN
	Individual professional last name
Provider First Name	CORBIN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	849 E 33RD ST
	Group Practice or individual's line 1 address
Line 2 Street Address	PSYCHOLOGICAL SERVICES FOR FAMILIES
	Group Practice or individual's line 2 address
City	EDMOND
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	730135407
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y