Individual
DR. JENNIFER LEE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
111 E. 16TH STREET, INNOVATIVE HEALTH CARE CONCEPTS INC., IDAHO FALLS, ID 83401
(208) 529-8526
Mailing address
111 E. 16TH STREET, INNOVATIVE HEALTH CARE CONCEPTS INC., IDAHO FALLS, ID 83401
(208) 529-8526
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
0810005625
VA
103TC0700X
Clinical Psychologist
Primary
PSY-203029
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/27/2013
Last updated
09/14/2017
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