Provider Demographics
NPI:1093924656
Name:COLWELL-LIPSON, COREY (MA, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:COREY
Middle Name:
Last Name:COLWELL-LIPSON
Suffix:
Gender:F
Credentials:MA, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 W BEAVER LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-8017
Mailing Address - Country:US
Mailing Address - Phone:206-818-7591
Mailing Address - Fax:
Practice Address - Street 1:3707 PROVIDENCE POINT DR SE
Practice Address - Street 2:SUITE G (LAKESIDE FAMILY PHYSICIANS)
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6216
Practice Address - Country:US
Practice Address - Phone:206-818-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-062221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist