MEDICARE: HENSEL O. WARD JR. PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4444	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093812190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENSEL O. WARD JR. PH.D.

Provider Business Mailing Address
First Line	:	2242 OLYMPIC ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2737
Country	:	US
Telephone Number	:	937-390-7773
Fax Number	:	937-390-8765

Provider Business Practice Location Address
First Line	:	2242 OLYMPIC ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-2737
Country	:	US
Telephone Number	:	937-390-7773
Fax Number	:	937-390-8765

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. HENSEL OWEN WARD
Credential	:	PH.D.
Telephone Number	:	937-390-7773

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/22/2024

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