Healthcare Provider Details

I. General information

NPI: 1114331121
Provider Name (Legal Business Name): ANIRA DAHLSTROM-HAKKI M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N MAIN ST UNIT A
SUNDERLAND MA
01375-9502
US

IV. Provider business mailing address

58 SOLAR WAY
GREENFIELD MA
01301-3872
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8717
  • Fax:
Mailing address:
  • Phone: 413-478-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6894
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: