Individual
JERRY HENLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LATC
Contact information
Practice address
322 N LEAVITT ST UNIT B, CHICAGO, IL 60612-1616
(312) 307-1813
Mailing address
825 W 59TH ST, LA GRANGE HIGHLANDS, IL 60525-7411
(312) 307-1813
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
01/14/2020
Last updated
01/14/2020
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