Provider Demographics
NPI:1871000919
Name:WONISH-MOTTIN, JENNA (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:WONISH-MOTTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:WONISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10901 DARMSTADT RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5027
Mailing Address - Country:US
Mailing Address - Phone:502-430-2256
Mailing Address - Fax:
Practice Address - Street 1:141 COMMUNICATION DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-603-1460
Practice Address - Fax:573-603-1462
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009559A1041C0700X
MO20180274531041C0700X
TX673001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical