Provider Demographics
NPI:1639342728
Name:ALLEN, DOLYNDA M
Entity Type:Individual
Prefix:
First Name:DOLYNDA
Middle Name:M
Last Name:ALLEN
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:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:MCKENNA
Mailing Address - State:WA
Mailing Address - Zip Code:98558-1066
Mailing Address - Country:US
Mailing Address - Phone:253-861-2530
Mailing Address - Fax:360-400-3566
Practice Address - Street 1:5511 112TH AVE E STE A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-5903
Practice Address - Country:US
Practice Address - Phone:360-970-2568
Practice Address - Fax:360-400-3566
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60198097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health