Provider Demographics
NPI:1033232715
Name:COLON, JEANNE M
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:M
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SILVERLAKE CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6701
Mailing Address - Country:US
Mailing Address - Phone:805-526-3081
Mailing Address - Fax:805-577-5986
Practice Address - Street 1:3150 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3940
Practice Address - Country:US
Practice Address - Phone:805-577-0830
Practice Address - Fax:805-581-2852
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator