Individual
KRISJAN MIKKEL HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MAT, LAT, ATC
Contact information
Practice address
604 ANSBOROUGH AVE, WATERLOO, IA 50701-5842
(319) 433-0130
Mailing address
1106 KENT CIR APT 7, WATERLOO, IA 50701-4479
(515) 829-6540
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
133126
IA
Other
Enumeration date
05/17/2023
Last updated
06/24/2025
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