Provider Demographics
NPI:1184684276
Name:COLBURN, MICHELLE WALTON (AUD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:WALTON
Last Name:COLBURN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1013 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2181
Mailing Address - Country:US
Mailing Address - Phone:860-233-2020
Mailing Address - Fax:
Practice Address - Street 1:1013 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2181
Practice Address - Country:US
Practice Address - Phone:860-233-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000509231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6058ZMedicare ID - Type Unspecified