Henderson, Gregory A
Henderson, Gregory A is an individual health care provider with primary practice located at 210 Wisconsin American Dr , Fond Du Lac WI 54937-2999. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Henderson, Gregory A can be contacted via phone (920) 907-7000.Contact Information
Primary practice address
210 Wisconsin American Dr
Fond Du Lac WI 54937-2999
Phone: (920) 907-7000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 6169-123 | Wisconsin |
Profile Details
| NPI number | 1982826509 |
|---|---|
| LBN Legal business name | Henderson, Gregory A |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 3rd, 2007 |
| Last updated | Sep 25th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982826509 | NPPES |
| Wisconsin | MEDICAID | 100003960 |
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