Healthcare Provider Details

I. General information

NPI: 1306090972
Provider Name (Legal Business Name): DOLORES ANN JIMERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97800
US

IV. Provider business mailing address

YELLOWHAWK TRIBAL HEALTH CENTER 46314 TIMINE WAY
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 307-857-6685
  • Fax: 307-857-6420
Mailing address:
  • Phone: 307-857-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-624
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: