Provider Demographics
NPI:1326025891
Name:ZOLLINGER, PRUDENCE (LCSW, ABD)
Entity type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:
Last Name:ZOLLINGER
Suffix:
Gender:
Credentials:LCSW, ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 IRELAND AVE
Mailing Address - Street 2:IRELAND ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5111
Mailing Address - Country:US
Mailing Address - Phone:502-624-9972
Mailing Address - Fax:502-624-9549
Practice Address - Street 1:850 SW 4TH ST STE 302
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9629
Practice Address - Country:US
Practice Address - Phone:541-475-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR120631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical