Provider Demographics
NPI:1659114791
Name:COLBURN, ISABELLA
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:COLBURN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:NICHOLLAI
Other - Middle Name:
Other - Last Name:MOLLOSEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1094 GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1924
Mailing Address - Country:US
Mailing Address - Phone:810-382-9161
Mailing Address - Fax:
Practice Address - Street 1:11174 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2702
Practice Address - Country:US
Practice Address - Phone:810-991-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician