Provider Demographics
NPI:1093082752
Name:DAHLSTROM, KATLYN ELIZABETH (SLP)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:ELIZABETH
Last Name:DAHLSTROM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:
Other - Last Name:MCGRATTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 CATTLE RANCH ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492
Mailing Address - Country:US
Mailing Address - Phone:585-613-1448
Mailing Address - Fax:
Practice Address - Street 1:3305 CENTRAL PARK VILLAGE DR STE 130
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-7707
Practice Address - Country:US
Practice Address - Phone:651-406-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4711 SPIN235Z00000X
MA77035235Z00000X
MN10172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist