Provider Demographics
NPI:1376265363
Name:WOLLIN, JACQUILYN E
Entity Type:Individual
Prefix:
First Name:JACQUILYN
Middle Name:E
Last Name:WOLLIN
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 1:3570 CAMINO DEL RIO N STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1747
Mailing Address - Country:US
Mailing Address - Phone:619-507-9333
Mailing Address - Fax:619-467-4595
Practice Address - Street 1:3570 CAMINO DEL RIO N STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1747
Practice Address - Country:US
Practice Address - Phone:619-507-9333
Practice Address - Fax:619-467-4595
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374J00000XNursing Service Related ProvidersDoula
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program