Provider Demographics
NPI:1184032161
Name:DOLEZAL, SARAH LOUISE (PLMHP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LOUISE
Last Name:DOLEZAL
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1743
Mailing Address - Country:US
Mailing Address - Phone:308-381-8851
Mailing Address - Fax:308-381-8853
Practice Address - Street 1:2313 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1743
Practice Address - Country:US
Practice Address - Phone:308-381-8851
Practice Address - Fax:308-381-8853
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10264101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026172100Medicaid
NE10026304600Medicaid