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NPI Code Detail

MEDICARE: HEATHER LAYNE DOLMAN LMSW

MEDICARE: HEATHER LAYNE DOLMAN LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker37796ID

General Provider Information

NPI Number : 1578049185
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER LAYNE DOLMAN LMSW
Provider Business Mailing Address
First Line : 906 FILLMORE ST
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4127
Country : US
Telephone Number : 740-644-5187
Fax Number :
Provider Business Practice Location Address
First Line : 709 DEARBORN ST
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4116
Country : US
Telephone Number : 208-376-7083
Fax Number : 208-402-5604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2018
Last Update Date : 07/17/2018

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Directions to “ HEATHER LAYNE DOLMAN LMSW” Practice Location

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