Provider Demographics
NPI:1316657117
Name:BOLLINGER, CAROLYN MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARIE
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 HUDSON BLVD N STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8706
Mailing Address - Country:US
Mailing Address - Phone:651-254-8580
Mailing Address - Fax:651-254-0601
Practice Address - Street 1:8550 HUDSON BLVD N STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8706
Practice Address - Country:US
Practice Address - Phone:651-254-8580
Practice Address - Fax:651-254-0601
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN280211041C0700X
WI11050-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical