MEDICARE: KATHLEEN DOLAN CLC

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
1	174N00000X	Lactation Consultant (Non-RN)	361290	MA

General Provider Information

NPI Number	:	1932917473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN DOLAN CLC

Provider Business Mailing Address
First Line	:	5729 JOHNSON ST
Second Line	:
City	:	BUZZARDS BAY
State	:	MA
Zip	:	02542-1403
Country	:	US
Telephone Number	:	207-332-8584
Fax Number	:

Provider Business Practice Location Address
First Line	:	5729 JOHNSON ST
Second Line	:
City	:	BUZZARDS BAY
State	:	MA
Zip	:	02542-1403
Country	:	US
Telephone Number	:	207-332-8584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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