=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265667059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACK WESTON SCHINDERLE MA LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2009
-----------------------------------------------------
Last Update Date | 05/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9247 N MERIDIAN ST 325
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-1879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-508-3161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 543 COVENTRY WAY
-----------------------------------------------------
City | NOBLESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46062-9024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-508-3161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34002303
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------