Provider Demographics
NPI:1811722705
Name:EKHOFF, JONATHAN EDWARD (EDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EDWARD
Last Name:EKHOFF
Suffix:
Gender:M
Credentials:EDS
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 8
Mailing Address - Street 2:
Mailing Address - City:BURKET
Mailing Address - State:IN
Mailing Address - Zip Code:46508-0008
Mailing Address - Country:US
Mailing Address - Phone:574-598-2600
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 8
Practice Address - Street 2:
Practice Address - City:BURKET
Practice Address - State:IN
Practice Address - Zip Code:46508-0008
Practice Address - Country:US
Practice Address - Phone:574-598-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1590434103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool