Provider Demographics
NPI:1114899630
Name:ENGLEHART, JOSHUA SCOTT
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCOTT
Last Name:ENGLEHART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 LA CROSSE ST APT 108
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4769
Mailing Address - Country:US
Mailing Address - Phone:779-423-9850
Mailing Address - Fax:
Practice Address - Street 1:8025 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5360
Practice Address - Country:US
Practice Address - Phone:515-271-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program