Provider Demographics
NPI:1033246160
Name:BOLLING, MADELON Y (PHD)
Entity Type:Individual
Prefix:
First Name:MADELON
Middle Name:Y
Last Name:BOLLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 23RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5806
Mailing Address - Country:US
Mailing Address - Phone:206-527-1190
Mailing Address - Fax:
Practice Address - Street 1:3245 FAIRVIEW AVE E
Practice Address - Street 2:SUITE 303
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3053
Practice Address - Country:US
Practice Address - Phone:206-779-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 3401103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical