Provider Demographics
NPI:1548509664
Name:BOLLER, JENNIFER RUTH (BCABA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RUTH
Last Name:BOLLER
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RUTH
Other - Last Name:HAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:1002 E 23RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116
Mailing Address - Country:US
Mailing Address - Phone:816-835-0262
Mailing Address - Fax:816-984-8281
Practice Address - Street 1:5863 NW 72ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1483
Practice Address - Country:US
Practice Address - Phone:816-984-8280
Practice Address - Fax:816-984-8281
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MO2014028750103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst