Provider Demographics
NPI:1255054243
Name:DAHLGREN, JANNA L (RBT)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:L
Last Name:DAHLGREN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 DOWNSHIRE HILL CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-5671
Mailing Address - Country:US
Mailing Address - Phone:580-890-0522
Mailing Address - Fax:
Practice Address - Street 1:2132 DOWNSHIRE HILL CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-5671
Practice Address - Country:US
Practice Address - Phone:580-890-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician