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NPI Code Detail

MEDICARE: BRETT DORSTEN

MEDICARE: BRETT DORSTEN
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
1103TS0200XSchool Psychologist20574555OH

General Provider Information

NPI Number : 1770984353
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRETT DORSTEN
Provider Business Mailing Address
First Line : 205 W CRAWFORD ST
Second Line :
City : VAN WERT
State : OH
Zip : 45891-1903
Country : US
Telephone Number : 419-238-0648
Fax Number :
Provider Business Practice Location Address
First Line : 205 W CRAWFORD ST
Second Line :
City : VAN WERT
State : OH
Zip : 45891-1903
Country : US
Telephone Number : 419-238-0648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2014
Last Update Date : 09/15/2014

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Directions to “ BRETT DORSTEN ” Practice Location

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