Individual
SALLY JANE HENRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN/LCSW
Contact information
Practice address
800 N TUCKER BLVD, SAINT LOUIS, MO 63101-1114
(314) 802-1975
(314) 802-1983
Mailing address
800 N TUCKER BLVD, SAINT LOUIS, MO 63101-1114
(314) 802-1975
(314) 802-1983
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
075944
MO
Other
Enumeration date
06/08/2009
Last updated
06/08/2009
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