Healthcare Provider Details

I. General information

NPI: 1144410101
Provider Name (Legal Business Name): CONNIE S DAHL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 6TH AVE S
WOLF POINT MT
59201-1517
US

IV. Provider business mailing address

505 JOHNSON ST
WOLF POINT MT
59201-1817
US

V. Phone/Fax

Practice location:
  • Phone: 406-653-1200
  • Fax: 406-653-3104
Mailing address:
  • Phone: 406-653-1472
  • Fax: 406-494-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number756
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: