Provider Demographics
NPI:1396139135
Name:HENRICH, STEPHEN
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:HENRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 RED FOX CT
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2573
Mailing Address - Country:US
Mailing Address - Phone:641-420-4451
Mailing Address - Fax:
Practice Address - Street 1:216 RED FOX CT
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2573
Practice Address - Country:US
Practice Address - Phone:641-420-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program