Heather Henderson, RN BSN IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

L-317510 Issued in IL

Practice address

1621 W Carroll Ave
Chicago, IL 60612-2501

Phone

(217) 508-9082

NPI assigned

Jan 13, 2025

Last updated

Jan 13, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Heather Gentry Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1891505616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "839 SHERWOOD PL",
            "city": "CHARLESTON",
            "state": "IL",
            "postal_code": "619201724",
            "telephone_number": "217-508-9082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 W CARROLL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122501",
            "telephone_number": "217-508-9082"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "839 Sherwood Pl",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "IL",
            "postal_code": "619201724",
            "country_code": "US",
            "telephone_number": "217-508-9082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "HEATHER",
        "credential": "RN BSN IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-13",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "IL",
            "license": "L-317510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "GENTRY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cynthia Henderson, M.D.
• Daunte Martez Henderson, LCSW
• Edward Bruce Henderson, PHD, LCSW
• Elena Kelsey Henderson, PHD
• Germaine M Henderson
• Jayme Lea Henderson, DNP, APRN, CNM
• Jordan Seville Henderson, LPC
• Joseph R Henderson
• Julius Melvin Henderson Jr., MD
• Keianna Henderson

• Lactation Consultant (Registered Nurse) in Chicago, IL
• Providers in Chicago, IL by specialty
• Lactation Consultant (Registered Nurse) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.