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General NPI Number Information
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NPI Number | 1033714944
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Entity Type | Organization
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Legal Business Name | DAHLIA CENTER FOR PERINATAL MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 7431 E STATE ST # 306
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City | ROCKFORD
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State | IL
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Zip | 61108-2678
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Country | US
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Telephone | 815-270-8700
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Fax | 719-888-1821
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Provider Business Mailing Address
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Address Line | 7431 E STATE ST # 306
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City | ROCKFORD
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State | IL
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Zip | 61108-2678
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA HAHN
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Credential | APN
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Telephone | 815-270-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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