Provider Demographics
NPI:1063732485
Name:BOLLINGER, TIFFANY MESSICK (CSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MESSICK
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CALBOURNE LN
Mailing Address - Street 2:I-1
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2085
Mailing Address - Country:US
Mailing Address - Phone:801-860-1666
Mailing Address - Fax:
Practice Address - Street 1:9263 REDWOOD RD
Practice Address - Street 2:BUILDING 8 STE B
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6571
Practice Address - Country:US
Practice Address - Phone:801-566-0749
Practice Address - Fax:801-566-7108
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6409387-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical