Provider Demographics
NPI:1114148103
Name:COLBA, BARBARA L (SLP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:COLBA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 COURT ST RM 503
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-1976
Mailing Address - Country:US
Mailing Address - Phone:715-743-5192
Mailing Address - Fax:715-743-5209
Practice Address - Street 1:517 COURT ST RM 503
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1976
Practice Address - Country:US
Practice Address - Phone:715-743-5192
Practice Address - Fax:715-743-5209
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2597-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42565800Medicaid