Provider Demographics
NPI:1083451165
Name:BOLLUM, ABBY CHRISTINE (LADC)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:CHRISTINE
Last Name:BOLLUM
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7701 YORK AVE S
Mailing Address - Street 2:STE 350
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-926-2526
Mailing Address - Fax:952-926-6791
Practice Address - Street 1:7701 YORK AVE S
Practice Address - Street 2:STE 350
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-926-2526
Practice Address - Fax:952-926-6791
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN306579101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)