Provider Demographics
NPI:1063593515
Name:DOLLINGER, SCOTT A (PSYD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:DOLLINGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4988
Mailing Address - Country:US
Mailing Address - Phone:630-792-1343
Mailing Address - Fax:
Practice Address - Street 1:1920 S HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4988
Practice Address - Country:US
Practice Address - Phone:630-792-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01927632OtherBLUE CROSS / BLUE SHIELD
IL01927632OtherBLUE CROSS / BLUE SHIELD
ILK18516Medicare ID - Type UnspecifiedINDIVIDUAL