Provider Demographics
NPI:1174020465
Name:EGELAND, JOSHUA (LSW)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:EGELAND
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GUNCKEL AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1726
Mailing Address - Country:US
Mailing Address - Phone:937-972-8106
Mailing Address - Fax:
Practice Address - Street 1:605 S PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2649
Practice Address - Country:US
Practice Address - Phone:937-815-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1501282104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker