Provider Demographics
NPI:1275267197
Name:KOLB, KALEB ISAAC
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:ISAAC
Last Name:KOLB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 BOY SCOUT RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-1336
Mailing Address - Country:US
Mailing Address - Phone:989-460-7932
Mailing Address - Fax:
Practice Address - Street 1:7110 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9310
Practice Address - Country:US
Practice Address - Phone:989-460-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician