Provider Demographics
NPI:1790064186
Name:BOLLINGER, MARY CLARE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CLARE
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 THOMPSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2241
Mailing Address - Country:US
Mailing Address - Phone:660-826-3700
Mailing Address - Fax:
Practice Address - Street 1:915 SOUTHWEST BLVD STE F
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5014
Practice Address - Country:US
Practice Address - Phone:573-556-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022850237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist