Provider Demographics
NPI:1477352706
Name:HAMILTON, DANA BROOKE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:BROOKE
Last Name:HAMILTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 CLYDIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-1801
Mailing Address - Country:US
Mailing Address - Phone:219-466-4706
Mailing Address - Fax:
Practice Address - Street 1:4840 GRASSELLI ST
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3503
Practice Address - Country:US
Practice Address - Phone:219-397-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician