Provider Demographics
NPI:1881078145
Name:DAHLEN, WANDA J (PHD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:J
Last Name:DAHLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:WANDA
Other - Middle Name:J
Other - Last Name:MCSPARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:928 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-2839
Mailing Address - Country:US
Mailing Address - Phone:218-847-1676
Mailing Address - Fax:
Practice Address - Street 1:928 8TH ST SE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2839
Practice Address - Country:US
Practice Address - Phone:218-847-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4577103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling