Individual
MR. GREGORY A HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
210 WISCONSIN AMERICAN DR, FOND DU LAC, WI 54937-2999
(920) 907-7000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6169-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003960
—
WI
Enumeration date
05/03/2007
Last updated
09/25/2023
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