Provider Demographics
NPI:1306990999
Name:BOLTON, JOLENE
Entity type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:
Last Name:BOLTON
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 1:14106 SE 278TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-7406
Mailing Address - Country:US
Mailing Address - Phone:253-630-5502
Mailing Address - Fax:
Practice Address - Street 1:33600 6TH AVE S
Practice Address - Street 2:SUITE #108
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6743
Practice Address - Country:US
Practice Address - Phone:253-661-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002702103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist