Individual
NICOLE DAHLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9426 LIMA RD, FORT WAYNE, IN 46818-8680
(260) 497-0328
Mailing address
9426 LIMA RD, FORT WAYNE, IN 46818-8680
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
46003357A
IN
Other
Enumeration date
07/23/2018
Last updated
07/23/2018
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