Provider Demographics
NPI:1386852879
Name:RAINBOW, JON WILLIAM (MDIV, MA, MSW)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:WILLIAM
Last Name:RAINBOW
Suffix:
Gender:M
Credentials:MDIV, MA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 S BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2632
Mailing Address - Country:US
Mailing Address - Phone:502-639-7919
Mailing Address - Fax:
Practice Address - Street 1:334 S BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2632
Practice Address - Country:US
Practice Address - Phone:502-639-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist