Provider Demographics
NPI:1174058564
Name:HENRY, JOI (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOI
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6806
Mailing Address - Country:US
Mailing Address - Phone:630-221-1400
Mailing Address - Fax:630-221-1411
Practice Address - Street 1:30 N MICHIGAN AVE STE 424
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3844
Practice Address - Country:US
Practice Address - Phone:312-279-9981
Practice Address - Fax:312-279-9981
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024578363LP0808X, 363LP0808X
IL309.018490363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL309.018490OtherCONTROLLED SUBSTANCE
IL0414499595OtherRN
IL041.449595OtherSTATE OF ILLINOIS
IL209.024578OtherSTATE OF ILLINOIS
MH7197355OtherDEA