Provider Demographics
NPI:1447965975
Name:WOLLINGER, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:WOLLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 WOODVIEW CT APT 15
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1943
Mailing Address - Country:US
Mailing Address - Phone:608-921-0040
Mailing Address - Fax:
Practice Address - Street 1:4785 HAYES RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7364
Practice Address - Country:US
Practice Address - Phone:608-921-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist