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NPI Code Detail

MEDICARE: AMY K HENRIKSON SSP, LCPC

MEDICARE: AMY K HENRIKSON SSP, LCPC
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
1101YP2500XProfessional Counselor180.011884IL

General Provider Information

NPI Number : 1588920946
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY K HENRIKSON SSP, LCPC
Provider Business Mailing Address
First Line : 386 MILL ST
Second Line :
City : BATAVIA
State : IL
Zip : 60510-9252
Country : US
Telephone Number : 630-346-2578
Fax Number :
Provider Business Practice Location Address
First Line : 110 E COUNTRYSIDE PKWY
Second Line :
City : YORKVILLE
State : IL
Zip : 60560-1813
Country : US
Telephone Number : 630-553-1600
Fax Number : 630-553-7993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2012
Last Update Date : 12/21/2022

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