Provider Demographics
NPI:1912916750
Name:DAHLEN, ELIZABETH MARY III (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARY
Last Name:DAHLEN
Suffix:III
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:207 RAMSLAND ST
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-1031
Mailing Address - Country:US
Mailing Address - Phone:608-634-2352
Mailing Address - Fax:
Practice Address - Street 1:2935 EAST AVE S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7243
Practice Address - Country:US
Practice Address - Phone:608-787-5572
Practice Address - Fax:608-787-7775
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2274-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist