MEDICARE: MS. RITA HENRY

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	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1144729534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RITA HENRY

Provider Business Mailing Address
First Line	:	3400 AURORA AVE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-4866
Country	:	US
Telephone Number	:	515-779-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 73RD ST STE G
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1339
Country	:	US
Telephone Number	:	515-779-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	02/12/2018

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