Individual
DR. BILL LEE HENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
627 WINTER ST NE, SALEM, OR 97301-2428
(503) 931-5025
(503) 371-3839
Mailing address
627 WINTER ST NE, SALEM, OR 97301-2428
(503) 931-5025
(503) 371-3839
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0614
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
064073000
REGENCE BC PROVIDER#
OR
01
—
110791
OMAP PROVIDER NUMBER
OR
01
—
1770574741
HEALTH NET
OR
01
—
559447
VALUE OPTIONS MHS#
OR
01
—
906669
SALEM HOSP MED STAFF ID #
OR
01
—
N54264777
UBH PROVIDER ID
OR
Enumeration date
10/31/2005
Last updated
12/23/2008
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