Provider Demographics
NPI:1881795391
Name:JACKISCH, RHONDA S (LMHC)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:S
Last Name:JACKISCH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 AIRPORT NORTH OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6711
Mailing Address - Country:US
Mailing Address - Phone:260-489-8391
Mailing Address - Fax:260-489-6952
Practice Address - Street 1:813 AIRPORT NORTH OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6711
Practice Address - Country:US
Practice Address - Phone:260-489-8391
Practice Address - Fax:260-489-6952
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000186A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health