Provider Demographics
NPI:1265667059
Name:SCHINDERLE, JACK WESTON (MA LCSW)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:WESTON
Last Name:SCHINDERLE
Suffix:
Gender:M
Credentials:MA LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 COVENTRY WAY
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9024
Mailing Address - Country:US
Mailing Address - Phone:317-508-3161
Mailing Address - Fax:
Practice Address - Street 1:9247 N MERIDIAN ST
Practice Address - Street 2:325
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1879
Practice Address - Country:US
Practice Address - Phone:317-508-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340023031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN147560Medicare PIN