Provider Demographics
NPI:1144981226
Name:CARLSON-DOLLEN, ALICIN K
Entity type:Individual
Prefix:
First Name:ALICIN
Middle Name:K
Last Name:CARLSON-DOLLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 WICHITA AVE
Mailing Address - Street 2:
Mailing Address - City:PERSIA
Mailing Address - State:IA
Mailing Address - Zip Code:51563-4070
Mailing Address - Country:US
Mailing Address - Phone:402-658-5740
Mailing Address - Fax:
Practice Address - Street 1:2985 WICHITA AVE
Practice Address - Street 2:
Practice Address - City:PERSIA
Practice Address - State:IA
Practice Address - Zip Code:51563-4070
Practice Address - Country:US
Practice Address - Phone:402-658-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health