| Joan Louise Pontius | |
|
219 N Dixie Way Suite135 South Bend IN 46637-3369 | |
| (574) 360-3305 | |
| (574) 271-3740 |
| Full Name | Joan Louise Pontius |
|---|---|
| Speciality | Counselor - Professional |
| Location | 219 N Dixie Way, South Bend, Indiana |
| Authorized Official Name and Position | Joan Louise Pontius (THERAPIST) |
| Authorized Official Contact | 5743603305 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Joan Louise Pontius 219 N Dixie Way Suite135 South Bend IN 46637-3369 Ph: (574) 360-3305 | Joan Louise Pontius 219 N Dixie Way Suite135 South Bend IN 46637-3369 Ph: (574) 360-3305 |
| NPI Number | 1336574748 |
|---|---|
| Provider Enumeration Date | 09/05/2013 |
| Last Update Date | 09/05/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336574748 | NPI | - | NPPES |
| 1700138492 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (Indiana) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Indiana) | Secondary |
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