Provider Demographics
NPI:1710923958
Name:BOLLMAN, JILL KRISTEN (MS CCC A)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:KRISTEN
Last Name:BOLLMAN
Suffix:
Gender:F
Credentials:MS CCC A
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:KRISTEN
Other - Last Name:SALSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 E SHERMAN BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1854
Mailing Address - Country:US
Mailing Address - Phone:231-739-7646
Mailing Address - Fax:231-737-0505
Practice Address - Street 1:1560 E SHERMAN BLVD STE 250
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1854
Practice Address - Country:US
Practice Address - Phone:231-739-7646
Practice Address - Fax:231-737-0505
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000173231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist