MEDICARE: MR. JACK WESTON SCHINDERLE MA LCSW

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	1041C0700X	Clinical Social Worker	34002303	IN

General Provider Information

NPI Number	:	1265667059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACK WESTON SCHINDERLE MA LCSW

Provider Business Mailing Address
First Line	:	543 COVENTRY WAY
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46062-9024
Country	:	US
Telephone Number	:	317-508-3161
Fax Number	:

Provider Business Practice Location Address
First Line	:	9247 N MERIDIAN ST
Second Line	:	325
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1879
Country	:	US
Telephone Number	:	317-508-3161
Fax Number	:

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

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	05/21/2009

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