Healthcare Provider Details

I. General information

NPI: 1487298733
Provider Name (Legal Business Name): DAKOTA HARTZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MEDIC WAY
GREENCASTLE IN
46135-2296
US

IV. Provider business mailing address

5101 E US HIGHWAY 36 STE 100
AVON IN
46123-6646
US

V. Phone/Fax

Practice location:
  • Phone: 888-714-1927
  • Fax: 317-745-9565
Mailing address:
  • Phone: 888-714-1927
  • Fax: 317-745-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: