Healthcare Provider Details

I. General information

NPI: 1598913428
Provider Name (Legal Business Name): ELISABETH W DAHL MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CAMINO SIERRA VIS # 125 SANTA FE
SANTA FE NM
87505-1007
US

IV. Provider business mailing address

PO BOX 31502
SANTA FE NM
87594-1502
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-2504
  • Fax:
Mailing address:
  • Phone: 214-606-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4132
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: