Provider Demographics
NPI:1326025891
Name:ZOLLINGER, PRUDENCE (LCSW, ABD)
Entity Type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:
Last Name:ZOLLINGER
Suffix:
Gender:F
Credentials:LCSW, ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 IRELAND AVE
Mailing Address - Street 2:IRELAND ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5111
Mailing Address - Country:US
Mailing Address - Phone:502-624-9972
Mailing Address - Fax:502-624-9549
Practice Address - Street 1:289 IRELAND AVE
Practice Address - Street 2:IRELAND ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5111
Practice Address - Country:US
Practice Address - Phone:502-624-9972
Practice Address - Fax:502-624-9549
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical