Provider Demographics
NPI:1770748410
Name:DAHMEN, JILL JANEL SOVINE (MA, LP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:JANEL SOVINE
Last Name:DAHMEN
Suffix:
Gender:F
Credentials:MA, LP
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 404
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-0404
Mailing Address - Country:US
Mailing Address - Phone:320-630-6422
Mailing Address - Fax:507-702-1063
Practice Address - Street 1:501 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3280
Practice Address - Country:US
Practice Address - Phone:320-630-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5148103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8891320-00OtherMINNESOTA DEPARTMENT OF HUMAN SERVICES