Provider Demographics
NPI:1457329237
Name:DOLIESLAGER, JAMIE DAWN (DAT, ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:DAWN
Last Name:DOLIESLAGER
Suffix:
Gender:F
Credentials:DAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 TWILITE TER
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1625
Mailing Address - Country:US
Mailing Address - Phone:651-491-3022
Mailing Address - Fax:
Practice Address - Street 1:260 TWILITE TER
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-1625
Practice Address - Country:US
Practice Address - Phone:651-491-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119702510390200000X
1197025102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program