Healthcare Provider Details

I. General information

NPI: 1558505446
Provider Name (Legal Business Name): JENNIFER LYNN DOLAN MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71780 SAN JACINTO DR STE F2
RANCHO MIRAGE CA
92270-5518
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 442-933-9152
  • Fax: 207-662-3185
Mailing address:
  • Phone: 207-662-4892
  • Fax: 207-662-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP4369
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41946
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA9881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: