Healthcare Provider Details

I. General information

NPI: 1134418007
Provider Name (Legal Business Name): SHELBY H BOLLENBACHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

IV. Provider business mailing address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-5980
  • Fax: 626-335-5989
Mailing address:
  • Phone: 626-335-5980
  • Fax: 626-335-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW81137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: