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General NPI Number Information
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NPI Number | 1306834221
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Entity Type | Individual
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Provider Name | JEAN BOLLER M.S.,CCC-A
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Gender | Female
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 603 E HILDEBRAND AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2693
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Country | US
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Telephone | 210-824-0063
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Fax | 210-824-8514
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Provider Business Mailing Address
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Address Line | 603 E HILDEBRAND AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2693
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Country | US
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Telephone | 210-824-0063
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Fax | 210-824-8514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 50862
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 50862
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 50862
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License Number State | TX
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