Provider Demographics
NPI:1245261585
Name:SHEELER, LESLIE JENSEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:JENSEN
Last Name:SHEELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 PARKER OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2146
Mailing Address - Country:US
Mailing Address - Phone:414-899-6675
Mailing Address - Fax:
Practice Address - Street 1:701 N ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-9744
Practice Address - Country:US
Practice Address - Phone:765-361-9767
Practice Address - Fax:765-361-0374
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IN34006180A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000708725OtherANTHEM BCBS
INM400036386Medicare PIN