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General NPI Number Information
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NPI Number | 1093176463
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Entity Type | Individual
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Provider Name | JONNA BULLER MSW,LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 225 N. MAIN ST., STE 5
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City | NORTH WEBSTER
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State | IN
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Zip | 46555
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Country | US
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Telephone | 574-834-1393
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Fax | 833-527-8322
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Provider Business Mailing Address
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Address Line | PO BOX 751
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City | NORTH WEBSTER
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State | IN
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Zip | 46555-0751
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Country | US
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Telephone | 574-834-1393
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Fax | 833-527-8322
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34008756A
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License Number State | IN
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