Provider Demographics
NPI:1275364150
Name:DAHLGREN, MAKENZIE ELAINE
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:ELAINE
Last Name:DAHLGREN
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 1:13229 S 48TH ST APT 3005
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5041
Mailing Address - Country:US
Mailing Address - Phone:308-520-3840
Mailing Address - Fax:
Practice Address - Street 1:3215 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2425
Practice Address - Country:US
Practice Address - Phone:308-520-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst