MEDICARE: DR. PATRICIA L. JINDRICH LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3493-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164546818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA L. JINDRICH LPC

Provider Business Mailing Address
First Line	:	6530 SHERIDAN RD
Second Line	:	SUITE 7
City	:	KENOSHA
State	:	WI
Zip	:	53143-5063
Country	:	US
Telephone Number	:	262-857-8707
Fax Number	:	262-862-7703

Provider Business Practice Location Address
First Line	:	6530 SHERIDAN RD
Second Line	:	SUITE 7
City	:	KENOSHA
State	:	WI
Zip	:	53143-5063
Country	:	US
Telephone Number	:	262-857-8707
Fax Number	:	262-862-7703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	09/26/2011

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