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General NPI Number Information
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NPI Number | 1144679432
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Entity Type | Individual
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Provider Name | AMBER DAWN BODAK LCSW, LSW, MSW,
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Gender | Female
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 800 MACARTHUR BLVD STE 5
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City | MUNSTER
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State | IN
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Zip | 46321-2917
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Country | US
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Telephone | 219-392-7025
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Fax | 219-392-7026
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 33005883A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34007390A
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License Number State | IN
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