Active NPI
Lisa Ann Dahlgren, PH. D.
- Clinical Psychologist
- Creve Coeur, MO
National Provider Identifier
1588722193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 01546
- Practice address
- 12400 Olive Blvd
Ste 205
Creve Coeur, MO 63141-6431 - Phone
- (636) 394-6210
- Fax
- (314) 275-2301
- NPI assigned
- Dec 5, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 01546 | MO | Primary |
Addresses
Primary practice location
12400 Olive Blvd
Ste 205
Creve Coeur, MO 63141-6431
Mailing address
12400 Olive Blvd
Ste 205
Creve Coeur, MO 63141-6431
Phone (636) 394-6210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28825 | Other | MO | ANTHEM BLUE CROSS BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1588722193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12400 OLIVE BLVD",
"address_2": "STE 205",
"city": "CREVE COEUR",
"state": "MO",
"postal_code": "631416431",
"telephone_number": "636-394-6210",
"fax_number": "314-275-2301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12400 OLIVE BLVD",
"address_2": "STE 205",
"city": "CREVE COEUR",
"state": "MO",
"postal_code": "631416431",
"telephone_number": "636-394-6210",
"fax_number": "314-275-2301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAHLGREN",
"first_name": "LISA",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PH. D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MO",
"license": "01546",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS BS",
"identifier": "28825",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Creve Coeur, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.