Provider Demographics
NPI:1255314613
Name:SCHONBACHLER, PATRICK J (HSPP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:SCHONBACHLER
Suffix:
Gender:M
Credentials:HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21909 N 72ND DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5261
Mailing Address - Country:US
Mailing Address - Phone:812-320-7681
Mailing Address - Fax:
Practice Address - Street 1:2621 E JEFFERSON ST
Practice Address - Street 2:ATTN: ANNE LAWSON
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3880
Practice Address - Country:US
Practice Address - Phone:574-269-0573
Practice Address - Fax:574-269-0573
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4603103TC0700X
IN20041467A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200233310AMedicaid