Provider Demographics
NPI:1033673249
Name:COLBERT, STEPHON J (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:STEPHON
Middle Name:J
Last Name:COLBERT
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 MARKETPLACE BLVD # 5033
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5730
Mailing Address - Country:US
Mailing Address - Phone:706-277-3917
Mailing Address - Fax:
Practice Address - Street 1:3675 MARKETPLACE BLVD # 5033
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5730
Practice Address - Country:US
Practice Address - Phone:770-627-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty