1144410101 NPI number — CONNIE S DAHL LCSW

Table of content: CONNIE S DAHL LCSW (NPI 1144410101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144410101 NPI number — CONNIE S DAHL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAHL
Provider First Name:
CONNIE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144410101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 JOHNSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOLF POINT
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59201-1817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-653-1472
Provider Business Mailing Address Fax Number:
406-494-1724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 6TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOLF POINT
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59201-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-653-1200
Provider Business Practice Location Address Fax Number:
406-653-3104
Provider Enumeration Date:
07/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  756 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 756 . This is a "STATE OF MONTANA LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".