Healthcare Provider Details

I. General information

NPI: 1437372893
Provider Name (Legal Business Name): HEATHER ELLEN BOLLIER BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 EL CAMINO AVE
CARMICHAEL CA
95608-4650
US

IV. Provider business mailing address

4301 BREUNER AVE
SACRAMENTO CA
95819-1558
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-4934
  • Fax: 916-609-5160
Mailing address:
  • Phone: 916-457-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: