Provider Demographics
NPI:1164546818
Name:JINDRICH, PATRICIA L (LPC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:JINDRICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 SHERIDAN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5063
Mailing Address - Country:US
Mailing Address - Phone:262-857-8707
Mailing Address - Fax:262-862-7703
Practice Address - Street 1:6530 SHERIDAN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5063
Practice Address - Country:US
Practice Address - Phone:262-857-8707
Practice Address - Fax:262-862-7703
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3493-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43706600OtherWISCONSIN MEDICAID