MEDICARE: MRS. JONI LEE BRADBERRY

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
1	101YM0800X	Mental Health Counselor	39005952A	IN

General Provider Information

NPI Number	:	1871431320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JONI LEE BRADBERRY

Provider Business Mailing Address
First Line	:	116 W JACKSON BLVD
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3019
Country	:	US
Telephone Number	:	574-522-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 W JACKSON BLVD
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-3019
Country	:	US
Telephone Number	:	574-522-3888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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