Provider Demographics
NPI:1215161823
Name:HENNINGSGAARD, JUDE MARTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDE
Middle Name:MARTIN
Last Name:HENNINGSGAARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2240
Mailing Address - Country:US
Mailing Address - Phone:218-722-8654
Mailing Address - Fax:218-723-8212
Practice Address - Street 1:405 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2240
Practice Address - Country:US
Practice Address - Phone:218-722-8654
Practice Address - Fax:218-723-8212
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist