MEDICARE: NATALIE A. BOLLON PCC-S

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	101YP2500X	Professional Counselor	E-0003799	OH

General Provider Information

NPI Number	:	1316022031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE A. BOLLON PCC-S

Provider Business Mailing Address
First Line	:	1260 MONROE ST NW
Second Line	:	SUITE 27N
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-4160
Country	:	US
Telephone Number	:	330-364-6488
Fax Number	:	330-364-3307

Provider Business Practice Location Address
First Line	:	1260 MONROE ST NW
Second Line	:	SUITE 27N
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-4160
Country	:	US
Telephone Number	:	330-364-6488
Fax Number	:	330-364-3307

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	11/25/2008

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