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General NPI Number Information
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NPI Number | 1477372126
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Entity Type | Individual
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Provider Name | JONATHAN ONUFROCK
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Gender | Male
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 4920 W 600 N
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City | FAIRLAND
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State | IN
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Zip | 46126-9464
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Country | US
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Telephone | 317-835-3006
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Fax |
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Provider Business Mailing Address
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Address Line | 10154 BLUE RIBBON BLVD
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City | FISHERS
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State | IN
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Zip | 46040-1374
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Country | US
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Telephone |
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Fax |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 10811222
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License Number State | IN
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