Provider Demographics
NPI:1215252911
Name:DAHL, LADONNA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LADONNA
Middle Name:
Last Name:DAHL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S. BROADWAY, #6
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462
Mailing Address - Country:US
Mailing Address - Phone:786-512-9983
Mailing Address - Fax:
Practice Address - Street 1:303 S BROADWAY APT 6
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3173
Practice Address - Country:US
Practice Address - Phone:786-512-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical