Provider Demographics
NPI:1285290866
Name:HENRY, JENNIFER (CHC, CRC, CLC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:CHC, CRC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15181 VAN BUREN BLVD SPC 5
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-5634
Mailing Address - Country:US
Mailing Address - Phone:951-807-6213
Mailing Address - Fax:
Practice Address - Street 1:15181 VAN BUREN BLVD SPC 5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-5634
Practice Address - Country:US
Practice Address - Phone:951-807-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator