Provider Demographics
NPI:1366222044
Name:DAHLEN, CHEENNA LYNE
Entity type:Individual
Prefix:MRS
First Name:CHEENNA
Middle Name:LYNE
Last Name:DAHLEN
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 1:4870 KAPOLEI PKWY APT 102
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3277
Mailing Address - Country:US
Mailing Address - Phone:808-498-7650
Mailing Address - Fax:
Practice Address - Street 1:1390 MILLER ST.
Practice Address - Street 2:HONOLULU
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician