Provider Demographics
NPI:1225153265
Name:DAHL, RICHARD KENNETH (MA, LADC, LICSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KENNETH
Last Name:DAHL
Suffix:
Gender:M
Credentials:MA, LADC, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MARKET ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5532
Mailing Address - Country:US
Mailing Address - Phone:507-454-3900
Mailing Address - Fax:
Practice Address - Street 1:111 MARKET ST STE 3A
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5532
Practice Address - Country:US
Practice Address - Phone:507-454-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300306101YA0400X
WI2177-132101YA0400X
WI41881231041C0700X
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN160735OtherUCARE
MNHP33638OtherHEALTHPARTNERS
MN5H947DAOtherBLUE CROSS & BLUE SHIELD