Individual
DAWN ELAINE BONTRAGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW , MDIV
Contact information
Practice address
203 E MISHAWAKA AVE, MISHAWAKA, IN 46545-6602
(574) 256-3699
(574) 256-3060
Mailing address
203 E MISHAWAKA AVE, MISHAWAKA, IN 46545-6602
(574) 256-3699
(574) 256-3060
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005207A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
237580EEEE
MEDICARE (ADMINASTAR FEDERAL)
IN
Enumeration date
08/11/2006
Last updated
03/30/2015
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