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General NPI Number Information
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NPI Number | 1912916750
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Entity Type | Individual
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Provider Name | ELIZABETH MARY DAHLEN III MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 2935 EAST AVE S
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City | LA CROSSE
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State | WI
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Zip | 54601-7243
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Country | US
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Telephone | 608-787-5572
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Fax | 608-787-7775
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Provider Business Mailing Address
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Address Line | 207 RAMSLAND ST
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City | WESTBY
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State | WI
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Zip | 54667-1031
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Country | US
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Telephone | 608-634-2352
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2274-154
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License Number State | WI
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