Provider Demographics
NPI:1598913428
Name:DAHL, ELISABETH W (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:W
Last Name:DAHL
Suffix:
Gender:F
Credentials:MS CCC-SLP
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 31502
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-1502
Mailing Address - Country:US
Mailing Address - Phone:214-606-1167
Mailing Address - Fax:
Practice Address - Street 1:1300 CAMINO SIERRA VIS # 125
Practice Address - Street 2:SANTA FE
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1007
Practice Address - Country:US
Practice Address - Phone:505-467-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist