Provider Demographics
NPI:1285231076
Name:ZOLLINGER, CLAYTON
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:
Last Name:ZOLLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 GLADEWOOD DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-9096
Mailing Address - Country:US
Mailing Address - Phone:574-538-8876
Mailing Address - Fax:
Practice Address - Street 1:3120 WINDSOR CT
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-5556
Practice Address - Country:US
Practice Address - Phone:574-267-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health