| Jean Brunk Lcsw Llc | |
|
117 S 5th St Goshen IN 46528-3711 | |
| (574) 231-7010 | |
| (574) 231-7135 |
| Full Name | Jean Brunk Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 117 S 5th St, Goshen, Indiana |
| Authorized Official Name and Position | Jean Brunk (OWNER) |
| Authorized Official Contact | 5742387849 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jean Brunk Lcsw Llc 117 S 5th St Goshen IN 46528-3711 Ph: (574) 231-7010 | Jean Brunk Lcsw Llc 117 S 5th St Goshen IN 46528-3711 Ph: (574) 231-7010 |
| NPI Number | 1124728019 |
|---|---|
| Provider Enumeration Date | 03/08/2023 |
| Last Update Date | 03/08/2023 |
| Certification Date | 03/08/2023 |
| Medicare PECOS PAC ID | 9739554767 |
|---|---|
| Medicare Enrollment ID | O20230405001291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124728019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jean Brunk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710130810 PECOS PAC ID: 4183788383 Enrollment ID: I20090203000562 |
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