Organization
FOGERTY MUSIC THERAPY, LLC
Active
Other names
Fogerty Music Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JONNETTA FOGERTY MM, MT-BC (OWNER, DIRECTOR)
(812) 340-9269
Entity
Organization
Contact information
Practice address
515 S WOODSCREST DR STE B, BLOOMINGTON, IN 47401-5303
(812) 340-9269
Mailing address
4729 SHALIMAR DR, COLUMBIA, SC 29206-1048
(812) 340-9269
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
—
—
Other
Enumeration date
11/01/2011
Last updated
03/16/2016
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