Provider Demographics
NPI:1336785831
Name:CALLAHAN, DAKOTA JACK (CSW, MSW)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:JACK
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:CSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4765
Mailing Address - Country:US
Mailing Address - Phone:435-862-8273
Mailing Address - Fax:
Practice Address - Street 1:377 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4765
Practice Address - Country:US
Practice Address - Phone:435-862-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical