Healthcare Provider Details

I. General information

NPI: 1962113878
Provider Name (Legal Business Name): EMILY ANNE DOLSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 BOULDER POND DR
ANN ARBOR MI
48108-8625
US

IV. Provider business mailing address

4076 BOULDER POND DR
ANN ARBOR MI
48108-8625
US

V. Phone/Fax

Practice location:
  • Phone: 734-274-9267
  • Fax:
Mailing address:
  • Phone: 734-274-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019212
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: