Healthcare Provider Details

I. General information

NPI: 1245261585
Provider Name (Legal Business Name): LESLIE JENSEN SHEELER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE ANN JENSEN

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N ENGLEWOOD DR
CRAWFORDSVILLE IN
47933-9744
US

IV. Provider business mailing address

609 PARKER OAKS WAY
BROWNSBURG IN
46112-2146
US

V. Phone/Fax

Practice location:
  • Phone: 765-361-9767
  • Fax: 765-361-0374
Mailing address:
  • Phone: 414-899-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006180A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: