Provider Demographics
NPI:1003943804
Name:DAHLEN, KATHRYN MICHELLE (LMP,CCT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MICHELLE
Last Name:DAHLEN
Suffix:
Gender:F
Credentials:LMP,CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 NW 80TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4131
Mailing Address - Country:US
Mailing Address - Phone:206-789-0171
Mailing Address - Fax:
Practice Address - Street 1:700 NW 42ND ST
Practice Address - Street 2:#234
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4505
Practice Address - Country:US
Practice Address - Phone:206-226-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist