MEDICARE: JESSICA BOLLIN

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	103T00000X	Psychologist	41144	TX
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1649843012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BOLLIN

Provider Business Mailing Address
First Line	:	8915 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-1717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 S SHERMAN ST STE 211
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-6510
Country	:	US
Telephone Number	:	469-665-8036
Fax Number	:

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

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	06/05/2026

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Directions to “ JESSICA BOLLIN ” Practice Location

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