Healthcare Provider Details

I. General information

NPI: 1336176288
Provider Name (Legal Business Name): MARY JEAN SCHWENDENER-HOLT PHD HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY JEAN SCHWENDENER PH.D. HSPP

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N 15TH ST
RICHMOND IN
47374-3303
US

IV. Provider business mailing address

103 N 15TH ST
RICHMOND IN
47374-3303
US

V. Phone/Fax

Practice location:
  • Phone: 765-966-8000
  • Fax: 765-966-8000
Mailing address:
  • Phone: 765-966-8000
  • Fax: 765-966-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040995A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: