Provider Demographics
NPI:1528395431
Name:DAHLGREN, TAMMY (BCBA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:DAHLGREN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CAMDEN CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3611
Mailing Address - Country:US
Mailing Address - Phone:256-325-1712
Mailing Address - Fax:
Practice Address - Street 1:1900 GOLF RD SW STE E
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4319
Practice Address - Country:US
Practice Address - Phone:256-882-2457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-09-5658103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst