Healthcare Provider Details

I. General information

NPI: 1740661875
Provider Name (Legal Business Name): DENISE BOLLINGER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 S VAL VISTA DR SUITE B101
GILBERT AZ
85298-7325
US

IV. Provider business mailing address

4902 S VAL VISTA DR SUITE B101
GILBERT AZ
85298-7325
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-8866
  • Fax: 480-855-8867
Mailing address:
  • Phone: 480-855-8866
  • Fax: 480-855-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberSLP0081
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: