Healthcare Provider Details

I. General information

NPI: 1366049090
Provider Name (Legal Business Name): DANA BOBALIK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N VANDEMARK RD
SIDNEY OH
45365-3567
US

IV. Provider business mailing address

11191 NEW CARLISLE PIKE
NEW CARLISLE OH
45344-8512
US

V. Phone/Fax

Practice location:
  • Phone: 937-622-7393
  • Fax:
Mailing address:
  • Phone: 937-304-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0800829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: