1316207509 NPI number — MISS COLLEEN ELIZABETH COLEY M.S., BCBA

Table of content: MISS COLLEEN ELIZABETH COLEY M.S., BCBA (NPI 1316207509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316207509 NPI number — MISS COLLEEN ELIZABETH COLEY M.S., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEY
Provider First Name:
COLLEEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.S., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316207509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 S WACKER DR
Provider Second Line Business Mailing Address:
84TH FLOOR
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60606-7147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8833 GROSS POINT RD
Provider Second Line Business Practice Location Address:
STE. 309
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60077-1859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-441-0402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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