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NPI Code Detail

MEDICARE: DR. SALLY JEAN HENDERSON PH.D. LMFT LMSW

MEDICARE: DR. SALLY JEAN HENDERSON PH.D. LMFT LMSW
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
1106H00000XMarriage & Family Therapist00142IA
2104100000XSocial Worker04884IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2232194OTHERIAMIDLANDS CHOICE CACTUS ID

General Provider Information

NPI Number : 1790829968
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SALLY JEAN HENDERSON PH.D. LMFT LMSW
Provider Business Mailing Address
First Line : 673 WESTBURY DRIVE
Second Line : SUITE 201
City : IOWA CITY
State : IA
Zip : 52245-2723
Country : US
Telephone Number : 319-356-6352
Fax Number : 319-358-2367
Provider Business Practice Location Address
First Line : 673 WESTBURY DRIVE
Second Line : SUITE 201
City : IOWA CITY
State : IA
Zip : 52245-2723
Country : US
Telephone Number : 319-356-6352
Fax Number : 319-358-2367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 05/04/2011

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