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General NPI Number Information
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NPI Number | 1447965975
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Entity Type | Individual
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Provider Name | JACOB WOLLINGER
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Gender | Male
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 4785 HAYES RD
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City | MADISON
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State | WI
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Zip | 53704-7364
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Country | US
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Telephone | 608-921-0040
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 WOODVIEW CT APT 15
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City | MADISON
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State | WI
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Zip | 53713-1943
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Country | US
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Telephone | 608-921-0040
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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