Provider Demographics
NPI:1053105031
Name:DORBOLO, JON LOUIS
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:LOUIS
Last Name:DORBOLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 PEAR LOOP
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-8312
Mailing Address - Country:US
Mailing Address - Phone:541-915-0260
Mailing Address - Fax:
Practice Address - Street 1:1747 PEAR LOOP
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-8312
Practice Address - Country:US
Practice Address - Phone:541-915-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor