Provider Demographics
NPI:1245804376
Name:MINNICH, JONAH (HAD)
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:
Last Name:MINNICH
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-1415
Mailing Address - Country:US
Mailing Address - Phone:812-887-6518
Mailing Address - Fax:
Practice Address - Street 1:420 S STATE ROAD 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4061
Practice Address - Country:US
Practice Address - Phone:812-674-2334
Practice Address - Fax:812-674-2335
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001547A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist