Provider Demographics
NPI:1932917473
Name:DOLAN, KATHLEEN (CLC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5729 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02542-1403
Mailing Address - Country:US
Mailing Address - Phone:207-332-8584
Mailing Address - Fax:
Practice Address - Street 1:5729 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02542-1403
Practice Address - Country:US
Practice Address - Phone:207-332-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA361290174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN