MEDICARE: MS. MELISSA ANN BOLLINGER-KINNEY M.S.ED LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist
2	101YM0800X	Mental Health Counselor	226	MN

General Provider Information

NPI Number	:	1114074028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA ANN BOLLINGER-KINNEY M.S.ED LPC

Provider Business Mailing Address
First Line	:	6369 POLARIS LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3938
Country	:	US
Telephone Number	:	612-508-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	3021 HARBOR LN N STE 206
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-5120
Country	:	US
Telephone Number	:	763-559-1640
Fax Number	:	763-559-1617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/25/2018

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