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NPI Code Detail

MEDICARE: JESSICA BOLLINGER

MEDICARE: JESSICA BOLLINGER
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
1103K00000XBehavior AnalystLBA2144MD
2106S00000XBehavior TechnicianMD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508405168
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BOLLINGER
Provider Business Mailing Address
First Line : 8558 BLACK STAR CIR
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-2649
Country : US
Telephone Number : 240-918-2363
Fax Number :
Provider Business Practice Location Address
First Line : 8558 BLACK STAR CIR
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-2649
Country : US
Telephone Number : 240-918-2363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2019
Last Update Date : 04/21/2025

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