MEDICARE: ROSIE RED HENYARD 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
1	101YP2500X	Professional Counselor	180016490	IL

General Provider Information

NPI Number	:	1871179002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSIE RED HENYARD LCPC

Provider Business Mailing Address
First Line	:	2442 W 63RD CT
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-2869
Country	:	US
Telephone Number	:	630-999-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	6107 N GLENWOOD AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1894
Country	:	US
Telephone Number	:	630-999-5050
Fax Number	:

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

Provider Enumeration Date	:	03/18/2021
Last Update Date	:	03/27/2025

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