Individual
MR. JACK RUDY HENLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CST-LL
Contact information
Practice address
2101 GEER RD STE 120, TURLOCK, CA 95382-2456
(209) 664-8044
(209) 541-2114
Mailing address
2101 GEER RD STE 120, TURLOCK, CA 95382-2456
(209) 664-8044
(209) 541-2114
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
MPSS-FHKIAJ
CA
Other
Enumeration date
10/29/2018
Last updated
09/16/2025
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