Provider Demographics
NPI:1245072867
Name:DAHL, CASSANDRA LEA
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:LEA
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 1:20348 290TH ST
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-5067
Mailing Address - Country:US
Mailing Address - Phone:701-620-9515
Mailing Address - Fax:
Practice Address - Street 1:20348 290TH ST
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-5067
Practice Address - Country:US
Practice Address - Phone:701-620-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care