Healthcare Provider Details

I. General information

NPI: 1548552763
Provider Name (Legal Business Name): GWENDOLYN C DOLAND MS LMHC CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W HIGH ST
TOLEDO IA
52342-1319
US

IV. Provider business mailing address

103 W HIGH ST
TOLEDO IA
52342-1319
US

V. Phone/Fax

Practice location:
  • Phone: 515-577-4757
  • Fax:
Mailing address:
  • Phone: 515-577-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001397
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00197
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: