Provider Demographics
NPI:1316534282
Name:DAHL, BRIANNA L
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:L
Last Name:DAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 DAWN DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-4093
Mailing Address - Country:US
Mailing Address - Phone:989-207-0163
Mailing Address - Fax:
Practice Address - Street 1:1525 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-6425
Practice Address - Country:US
Practice Address - Phone:989-835-6333
Practice Address - Fax:989-835-4920
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician