Provider Demographics
NPI:1518978568
Name:KOEHLER, DAWN JULIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:JULIA
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 LAKE ST E
Mailing Address - Street 2:SUITE 222
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-6400
Mailing Address - Country:US
Mailing Address - Phone:952-476-5465
Mailing Address - Fax:952-936-9340
Practice Address - Street 1:641 LAKE ST E
Practice Address - Street 2:SUITE 222
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-6400
Practice Address - Country:US
Practice Address - Phone:952-476-5465
Practice Address - Fax:952-936-9340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical