Healthcare Provider Details

I. General information

NPI: 1255314613
Provider Name (Legal Business Name): PATRICK J SCHONBACHLER HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 E JEFFERSON ST ATTN: ANNE LAWSON
WARSAW IN
46580-3880
US

IV. Provider business mailing address

21909 N 72ND DR
GLENDALE AZ
85310-5261
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-0573
  • Fax: 574-269-0573
Mailing address:
  • Phone: 812-320-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4603
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041467A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: