Provider Demographics
NPI:1336176288
Name:SCHWENDENER-HOLT, MARY JEAN (PHD HSPP)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:SCHWENDENER-HOLT
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JEAN
Other - Last Name:SCHWENDENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD HSPP
Mailing Address - Street 1:103 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-3303
Mailing Address - Country:US
Mailing Address - Phone:765-966-8000
Mailing Address - Fax:765-966-8000
Practice Address - Street 1:103 N 15TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3303
Practice Address - Country:US
Practice Address - Phone:765-966-8000
Practice Address - Fax:765-966-8000
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040995A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200414750AMedicaid
11605380OtherCAHQ
IN000000347439OtherANTHEM
200950Medicare ID - Type Unspecified