Healthcare Provider Details

I. General information

NPI: 1235093105
Provider Name (Legal Business Name): JONATHEN DAHM
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 EASTERN BLVD
CLARKSVILLE IN
47129-2463
US

IV. Provider business mailing address

550 CONGRESSIONAL BLVD STE 115
CARMEL IN
46032-5644
US

V. Phone/Fax

Practice location:
  • Phone: 812-725-9025
  • Fax:
Mailing address:
  • Phone: 765-269-7756
  • Fax: 765-269-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: