Healthcare Provider Details

I. General information

NPI: 1568599157
Provider Name (Legal Business Name): JODY R LASHBROOK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY R MCKOON MSW, LCSW

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 SMITH ST
LOGANSPORT IN
46947-1576
US

IV. Provider business mailing address

8401 HARCOURT RD
INDIANAPOLIS IN
46260-2036
US

V. Phone/Fax

Practice location:
  • Phone: 574-732-1414
  • Fax: 574-732-0504
Mailing address:
  • Phone: 317-338-4703
  • Fax: 317-338-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005828A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: