Organization
HEALTHWISE PSYCHOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTIN B DAHL PSYD, LP (LICENSED PSYCHOLOGIST/OWNER)
(612) 599-5197
Entity
Organization
Contact information
Practice address
11280 86TH AVE N, MAPLE GROVE, MN 55369-4510
(763) 400-7828
(763) 400-7444
Mailing address
11280 86TH AVE N, MAPLE GROVE, MN 55369-4510
(763) 400-7828
(763) 400-7444
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
MN
1041C0700X
Clinical Social Worker
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
558677200
—
MN
01
—
H100135821
MEDICARE PTAN
MN
Enumeration date
01/31/2011
Last updated
05/29/2014
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