Provider Demographics
NPI:1700550449
Name:BOLLINGER, ANNA (SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W 11TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9255
Mailing Address - Country:US
Mailing Address - Phone:208-981-1111
Mailing Address - Fax:208-908-0060
Practice Address - Street 1:102 W 11TH AVE STE A
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9255
Practice Address - Country:US
Practice Address - Phone:208-981-1111
Practice Address - Fax:208-908-0060
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID202730021-2Medicaid