Individual provider Active NPI

Kalyn Dahl, LICSW

  • Clinical Social Worker
  • Spokane, WA
National Provider Identifier
1043980204
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW61464682 Issued in WA
Practice address
705 W 7TH Ave Ste I
Spokane, WA 99204-2847
Phone
(509) 863-4415
NPI assigned
Sep 17, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X LW61464682 WA Primary

Addresses

Primary practice location

705 W 7TH Ave Ste I
Spokane, WA 99204-2847

Mailing address

3312 E 27TH Ave
Spokane, WA 99223-4027
Phone (509) 863-4415

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jan 29, 2024 through Jan 29, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LW61464682WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Full Circle Therapy PLLC Clinical CurrentSince Apr 13, 2025 Accepting new patients
Grassroots Therapy Group LLC Clinical CurrentSince Jan 1, 2024 Accepting new patients

Locations

1212 N Washington St
Ste 204
Spokane, WA 99201
Phone (509) 290-5954

705 W 7th Ave
Ste I
Spokane, WA 99204
Phone (509) 863-4415

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1043980204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3312 E 27TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992234027",
            "telephone_number": "509-863-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 W 7TH AVE STE I",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042847",
            "telephone_number": "509-863-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHL",
        "first_name": "KALYN",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61464682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.