Provider Demographics
NPI:1033096961
Name:DOLAN, KIMBERLY (PSS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 BOEDIES DR
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1192
Mailing Address - Country:US
Mailing Address - Phone:971-283-6041
Mailing Address - Fax:
Practice Address - Street 1:1190 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1141
Practice Address - Country:US
Practice Address - Phone:503-393-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4948956175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist