Dakota Professional Corp

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5830 Issued in OH

Legal business name

DAKOTA PROFESSIONAL CORP

Practice address

3745 Shawnee Rd Ste 105
Lima, OH 45806-1662

Phone

(419) 999-2024

Fax

(419) 999-2024

NPI assigned

May 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Stacy L Fahlsing, PHDNPI 1457416158

Title

Ceo of Professional Psych Assoc

Phone

(419) 999-2024

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Professional Psychological Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacy L Fahlsing, DR.

  • Psychologist
  • Lima, OH
  • NPI 1457416158
  Medicare reassignment Care Compare group NPD Authorized official
• Kristine Marie Thackrey, LISW, LICDC

  • Addiction (Substance Use Disorder) Counselor
  • Lima, OH
  • NPI 1497819916
  Medicare reassignment Care Compare group NPD
• Ann Knoderer, LISW

  • Clinical Social Worker
  • Kent, OH
  • NPI 1629437694
  NPD (past)
• Michael Douglas Schafer, PH.D.

  • Clinical Psychologist
  • Lima, OH
  • NPI 1295759256
  NPD (past)

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574121600000",
    "number": "1083667828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3611 S DIXIE HWY",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "45804",
            "telephone_number": "419-999-2024",
            "fax_number": "419-999-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3745 SHAWNEE RD STE 105",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458061662",
            "telephone_number": "419-999-2024",
            "fax_number": "419-999-2024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAKOTA PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2019-11-19",
        "status": "A",
        "authorized_official_last_name": "FAHLSING",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO OF PROFESSIONAL PSYCH ASSOC",
        "authorized_official_telephone_number": "419-999-2024",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OH",
            "license": "5830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BWC RISK #1313922",
            "identifier": "47586656100",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Psychological Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Professional Psychological Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Danielle Dackin, PHYSICIAN ASSISTANT
• Sohrab Dadfar, PH.D.
• Jessica A Dailey, CNP
• Aubrey Lynn Daiss, DO
• Kelli Renee Daisy
• Elizabeth Dammeyer, PA
• Richard L Damschroder, MD
• Richard Lee Damschroder Jr., D.C.
• Dan G Wilker DDS
• Stephanie Danchisen, M.S., CCC-SLP

• Clinical Psychologist in Lima, OH
• Providers in Lima, OH by specialty
• Clinical Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.