Provider Demographics
NPI:1316042914
Name:DAHL, TEYA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:TEYA
Middle Name:
Last Name:DAHL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-0977
Mailing Address - Country:US
Mailing Address - Phone:507-446-0431
Mailing Address - Fax:507-446-8014
Practice Address - Street 1:115 LANDMARK DR NE
Practice Address - Street 2:SUITE 1
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5702
Practice Address - Country:US
Practice Address - Phone:507-446-0431
Practice Address - Fax:507-446-8014
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN091H0DAOtherBCBS