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General NPI Number Information
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NPI Number | 1023598182
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Entity Type | Individual
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Provider Name | ELISSA MARIE CROGHAN DAHL
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Gender | Female
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 144 RAILROAD AVE STE 213
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City | EDMONDS
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State | WA
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Zip | 98020-4121
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Country | US
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Telephone | 206-309-4128
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Fax |
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Provider Business Mailing Address
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Address Line | 18717 57TH PL W
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City | LYNNWOOD
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State | WA
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Zip | 98037-4557
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Country | US
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Telephone | 303-304-1174
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC60981319
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License Number State | WA
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