Provider Demographics
NPI:1215421458
Name:AGUILAR DAHLSTROM, ANALYSIA AMOR
Entity type:Individual
Prefix:MRS
First Name:ANALYSIA
Middle Name:AMOR
Last Name:AGUILAR DAHLSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 PENNSYLVANIA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4427
Mailing Address - Country:US
Mailing Address - Phone:630-474-4353
Mailing Address - Fax:
Practice Address - Street 1:420 PENNSYLVANIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137
Practice Address - Country:US
Practice Address - Phone:630-474-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health