Provider Demographics
NPI:1568130755
Name:BOLLINGER, JESSICA MARION
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARION
Last Name:BOLLINGER
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 1:604 S ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1632
Mailing Address - Country:US
Mailing Address - Phone:626-241-0966
Mailing Address - Fax:
Practice Address - Street 1:947 COLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2610
Practice Address - Country:US
Practice Address - Phone:323-871-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical