Provider Demographics
NPI:1548367568
Name:DAHNERT, MARY (LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DAHNERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N CHESTNUT ST
Mailing Address - Street 2:SUITE #203
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-3300
Mailing Address - Country:US
Mailing Address - Phone:612-750-3376
Mailing Address - Fax:952-368-3193
Practice Address - Street 1:510 N CHESTNUT ST
Practice Address - Street 2:SUITE #203
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-3300
Practice Address - Country:US
Practice Address - Phone:612-750-3376
Practice Address - Fax:952-368-3193
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN348M5DAMedicare UPIN