Provider Demographics
NPI:1093176463
Name:BULLER, JONNA (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:JONNA
Middle Name:
Last Name:BULLER
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:NORTH WEBSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46555-0751
Mailing Address - Country:US
Mailing Address - Phone:574-834-1393
Mailing Address - Fax:833-527-8322
Practice Address - Street 1:225 N. MAIN ST., STE 5
Practice Address - Street 2:
Practice Address - City:NORTH WEBSTER
Practice Address - State:IN
Practice Address - Zip Code:46555
Practice Address - Country:US
Practice Address - Phone:574-834-1393
Practice Address - Fax:833-527-8322
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008756A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical