Provider Demographics
NPI:1053891663
Name:HENRY, DAWN WENTAR (MBA CCC SLP)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:WENTAR
Last Name:HENRY
Suffix:
Gender:F
Credentials:MBA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 COUNTY ROAD 2600 N
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-9723
Mailing Address - Country:US
Mailing Address - Phone:217-778-3574
Mailing Address - Fax:
Practice Address - Street 1:402 COUNTY ROAD 2600 N
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9723
Practice Address - Country:US
Practice Address - Phone:217-778-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist