Provider Demographics
NPI:1215346309
Name:DAHLSTROM, KATHLEEN RENEE
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:RENEE
Last Name:DAHLSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:669 PALMETTO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-4065
Mailing Address - Country:US
Mailing Address - Phone:530-361-5303
Mailing Address - Fax:530-255-2152
Practice Address - Street 1:669 PALMETTO AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4065
Practice Address - Country:US
Practice Address - Phone:530-361-5303
Practice Address - Fax:530-255-2152
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist