Individual
MATTHEW HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2615 EDWARDS ST, ALTON, IL 62002-3915
(618) 462-2331
(618) 462-7160
Mailing address
902 W MAIN ST, WEST FRANKFORT, IL 62896-2210
(618) 937-6483
(618) 937-1440
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IL2970
—
IL
Enumeration date
03/04/2020
Last updated
03/04/2020
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