Healthcare Provider Details

I. General information

NPI: 1962280156
Provider Name (Legal Business Name): JESSICA SCHIFFHAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 18TH ST
LA PORTE IN
46350-6830
US

IV. Provider business mailing address

512 ANDREW AVE # 120
LA PORTE IN
46350-4633
US

V. Phone/Fax

Practice location:
  • Phone: 219-342-2415
  • Fax: 219-370-6088
Mailing address:
  • Phone: 219-342-2415
  • Fax: 219-370-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012501A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: