Provider Demographics
NPI:1467510842
Name:COLSON, EVA M (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:M
Last Name:COLSON
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:M
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:
Practice Address - Street 1:723 S WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:WI
Practice Address - Zip Code:54162-9303
Practice Address - Country:US
Practice Address - Phone:920-433-6073
Practice Address - Fax:920-432-6313
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40915200Medicaid
WI6885123OtherWI LICENSE