Provider Demographics
NPI:1255154019
Name:BOLAR, KAYLEE MAUDE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MAUDE
Last Name:BOLAR
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-4766
Mailing Address - Country:US
Mailing Address - Phone:773-733-3016
Mailing Address - Fax:
Practice Address - Street 1:555 S PERRYVILLE RD STE 222
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2527
Practice Address - Country:US
Practice Address - Phone:815-331-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker