Healthcare Provider Details

I. General information

NPI: 1881165934
Provider Name (Legal Business Name): TONIA DOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E ARCADIA AVE
PEORIA IL
61603-2506
US

IV. Provider business mailing address

600 E ARCADIA AVE
PEORIA IL
61603-2506
US

V. Phone/Fax

Practice location:
  • Phone: 309-868-7709
  • Fax:
Mailing address:
  • Phone: 309-868-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44897
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: