Provider Demographics
NPI:1427014752
Name:BIALIK, DAVID (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BIALIK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 44TH AVE S
Mailing Address - Street 2:PO BOX 14545
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3434
Mailing Address - Country:US
Mailing Address - Phone:701-775-2500
Mailing Address - Fax:701-787-8996
Practice Address - Street 1:1451 44TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3434
Practice Address - Country:US
Practice Address - Phone:701-775-2500
Practice Address - Fax:701-787-8996
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND29681041C0700X
MN119001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0418687000Medicaid
ND17397OtherND BC/BS
MN93D23BIOtherMN BC/BS
MN0418687000Medicaid