Provider Demographics
NPI:1740975341
Name:DAHLHEIM, KENNEDY MARIE
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:MARIE
Last Name:DAHLHEIM
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 1:514 W PLUM ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-3936
Mailing Address - Country:US
Mailing Address - Phone:562-220-8325
Mailing Address - Fax:
Practice Address - Street 1:16437 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5019
Practice Address - Country:US
Practice Address - Phone:562-220-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist