Provider Demographics
NPI:1255578159
Name:HENKEN, WINIFRED C (PHD, QMHP)
Entity type:Individual
Prefix:DR
First Name:WINIFRED
Middle Name:C
Last Name:HENKEN
Suffix:
Gender:F
Credentials:PHD, QMHP
Other - Prefix:DR
Other - First Name:WINIFRED
Other - Middle Name:C
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1975 MCPHERSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3482
Mailing Address - Country:US
Mailing Address - Phone:541-756-2020
Mailing Address - Fax:541-756-8982
Practice Address - Street 1:1975 MCPHERSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3482
Practice Address - Country:US
Practice Address - Phone:541-756-2020
Practice Address - Fax:541-756-8982
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11720103TC0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical