Healthcare Provider Details

I. General information

NPI: 1659852952
Provider Name (Legal Business Name): MELODIE M ONDECKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241
US

IV. Provider business mailing address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax: 317-548-7241
Mailing address:
  • Phone: 317-856-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007268A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: