Provider Demographics
NPI:1205055217
Name:SCOTT A. DOLLINGER
Entity type:Organization
Organization Name:SCOTT A. DOLLINGER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O. - CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-709-3526
Mailing Address - Street 1:1920 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4988
Mailing Address - Country:US
Mailing Address - Phone:630-792-1343
Mailing Address - Fax:630-576-5553
Practice Address - Street 1:1920 S HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4988
Practice Address - Country:US
Practice Address - Phone:630-792-1343
Practice Address - Fax:630-576-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.055689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211904Medicare ID - Type UnspecifiedGROUP NUMBER
ILDD6845Medicare ID - Type UnspecifiedRRB GROUP NUMBER