Provider Demographics
NPI:1134506082
Name:BOLLHAUER, SANDY
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:BOLLHAUER
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 1:35 SUNNYMEDE DR
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2816
Mailing Address - Country:US
Mailing Address - Phone:859-653-4128
Mailing Address - Fax:
Practice Address - Street 1:2816 BLUEGRASS DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1577
Practice Address - Country:US
Practice Address - Phone:859-442-8500
Practice Address - Fax:859-442-8555
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0624101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)