Individual
THEADORE JOSEPH HENLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QSP
Contact information
Practice address
604 2ND ST, REEDER, ND 58649-4939
(701) 498-0731
Mailing address
604 2ND ST, REEDER, ND 58649-4939
(701) 498-0731
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477909
—
ND
Enumeration date
10/21/2020
Last updated
10/21/2020
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