Provider Demographics
NPI:1578049185
Name:DOLMAN, HEATHER LAYNE (LMSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAYNE
Last Name:DOLMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4127
Mailing Address - Country:US
Mailing Address - Phone:740-644-5187
Mailing Address - Fax:
Practice Address - Street 1:709 DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4116
Practice Address - Country:US
Practice Address - Phone:208-376-7083
Practice Address - Fax:208-402-5604
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID37796104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker