| Doctor Name: | MICHAEL DEAN BONTRAGER |
| NPI Number: | 1043288814 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 34000388A |
| Business Practice Address: | 1807 Smith St Logansport, IN - 469471576 |
| Business Phone Number: | 5747321414 |
| Business Fax Number: | 5747320504 |
| Mailing Address: | 1807 Smith St, LOGANSPORT |
| State: | IN |
| Postal Code: | 469471576 |
| Phone Number: | 5747321414 |
| Fax Number: | 5747320504 |
| NPI Enumeration Date: | 03/09/2006 |
| NPI Last Update Date: | 09/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 34000388A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |