Provider Demographics
NPI:1821308354
Name:KISSEL, JODIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:A
Last Name:KISSEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:A
Other - Last Name:SCHLICHTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-858-3131
Mailing Address - Fax:812-858-3140
Practice Address - Street 1:4133 GATEWAY BLVD
Practice Address - Street 2:STE 220
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7953
Practice Address - Country:US
Practice Address - Phone:812-858-3131
Practice Address - Fax:812-858-3140
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005974A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN182780003Medicare PIN