Healthcare Provider Details

I. General information

NPI: 1710026331
Provider Name (Legal Business Name): KERRI L. BOLLINGER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S 11TH ST
TUCUMCARI NM
88401-3715
US

IV. Provider business mailing address

3604 QUAY ROAD 63.5
TUCUMCARI NM
88401-9627
US

V. Phone/Fax

Practice location:
  • Phone: 505-461-4344
  • Fax: 505-461-8033
Mailing address:
  • Phone: 505-461-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-06346
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-06346
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: