Provider Information for 1114511698
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JONAH COURLIONE MSW, LSW
Sex: Male
NPI: 1114511698
Last Updated: 2021-02-24
Certification Date: 2021-02-24
Certification Date: 2021-02-24
Details
| Name | Value | ||||||||
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| NPI | 1114511698 | ||||||||
| Enumeration Date | 2021-02-24 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 415 MULBERRY ST EVANSVILLE, IN 47713-1230 United States Phone: 812-423-7791 | Fax: | ||||||||
| Primary Practice Address | 60 S STOCKWELL RD EVANSVILLE, IN 47714-0247 United States Phone: 812-476-5437 | Fax: | ||||||||
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