Healthcare Provider Details

I. General information

NPI: 1871431320
Provider Name (Legal Business Name): MRS. JONI LEE BRADBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JONI LEE HOKE

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W JACKSON BLVD
ELKHART IN
46516-3019
US

IV. Provider business mailing address

116 W JACKSON BLVD
ELKHART IN
46516-3019
US

V. Phone/Fax

Practice location:
  • Phone: 574-522-3888
  • Fax:
Mailing address:
  • Phone: 574-522-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005952A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: