Provider Demographics
NPI:1982892568
Name:DAHLGREN, CARRIE DEANN (LMP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:DEANN
Last Name:DAHLGREN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 184TH ST SW STE E
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4717
Mailing Address - Country:US
Mailing Address - Phone:425-771-2626
Mailing Address - Fax:425-771-2611
Practice Address - Street 1:8512 242ND ST SW
Practice Address - Street 2:UNIT 7
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9076
Practice Address - Country:US
Practice Address - Phone:425-275-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist