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NPI Code Detail

MEDICARE: JONIKKA ELIZABETH VANCE LCSW

MEDICARE: JONIKKA ELIZABETH VANCE 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
11041C0700XClinical Social Worker34004954AIN

General Provider Information

NPI Number : 1043303514
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONIKKA ELIZABETH VANCE LCSW
Provider Business Mailing Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number : 812-337-2438
Provider Business Practice Location Address
First Line : 1315 HILLCREST RD
Second Line :
City : BEDFORD
State : IN
Zip : 47421-3023
Country : US
Telephone Number : 812-279-3591
Fax Number : 812-275-0787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 03/28/2012

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Directions to “ JONIKKA ELIZABETH VANCE LCSW” Practice Location

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