Provider Demographics
NPI:1487761094
Name:HENRY, BARBARA K (LCSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:K
Last Name:HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-0305
Mailing Address - Country:US
Mailing Address - Phone:920-894-7900
Mailing Address - Fax:920-894-7900
Practice Address - Street 1:317 FREMONT ST
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-1423
Practice Address - Country:US
Practice Address - Phone:920-894-7900
Practice Address - Fax:920-894-7900
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI506-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39254200Medicaid
WI944364Medicare PIN