MEDICARE: DASH THERAPY & COACHING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528699238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DASH THERAPY & COACHING

Provider Business Mailing Address
First Line	:	205 N MICHIGAN AVE STE 1660
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-6022
Country	:	US
Telephone Number	:	312-779-0730
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N MICHIGAN AVE STE 1660
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-6022
Country	:	US
Telephone Number	:	312-779-0730
Fax Number	:	773-825-8229

Authorized Official
Title or Position	:	CO-OWNER/THERAPIST
Name	:	MRS. NICOLE WOODCOX BOLDEN
Credential	:	LCSW
Telephone Number	:	312-779-0730

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	01/31/2020

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