Provider Demographics
NPI:1306344007
Name:GONTERMAN, JILLIAN (LCSW)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:GONTERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:SENTIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2909 S SARE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4331
Mailing Address - Country:US
Mailing Address - Phone:317-354-9820
Mailing Address - Fax:
Practice Address - Street 1:804 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3526
Practice Address - Country:US
Practice Address - Phone:812-219-4918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007566A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical