Individual
CAROLYN JEAN HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1881 CHICAGO ST, DE PERE, WI 54115-3770
(920) 403-8209
Mailing address
1881 CHICAGO ST, DE PERE, WI 54115-3770
(920) 403-8209
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
53895
MN
2084P0800X
Psychiatry Physician
Primary
63706
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
08/13/2008
Last updated
02/09/2022
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