Provider Demographics
NPI:1144871823
Name:DAHLING, KELSEY JANICE (BA)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JANICE
Last Name:DAHLING
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 W MAIN ST APT B8
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3634
Mailing Address - Country:US
Mailing Address - Phone:860-558-0279
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTH ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1967
Practice Address - Country:US
Practice Address - Phone:860-578-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC042019001704222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist