Provider Demographics
NPI:1073212809
Name:BOLINGER, JESSICA LEA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEA
Last Name:BOLINGER
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 1:2856 DUTCHMAN RD
Mailing Address - Street 2:
Mailing Address - City:MACFARLAN
Mailing Address - State:WV
Mailing Address - Zip Code:26148-6443
Mailing Address - Country:US
Mailing Address - Phone:304-481-6185
Mailing Address - Fax:
Practice Address - Street 1:2856 DUTCHMAN RD
Practice Address - Street 2:
Practice Address - City:MACFARLAN
Practice Address - State:WV
Practice Address - Zip Code:26148-6443
Practice Address - Country:US
Practice Address - Phone:304-481-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator