Provider Demographics
NPI:1164309720
Name:DAHLKE, JAY HULBERT (MSS, LSW)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:HULBERT
Last Name:DAHLKE
Suffix:
Gender:M
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6406
Mailing Address - Country:US
Mailing Address - Phone:267-463-0331
Mailing Address - Fax:
Practice Address - Street 1:403 E COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6406
Practice Address - Country:US
Practice Address - Phone:267-463-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1432521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical