Provider Demographics
NPI:1467786772
Name:GABA, COLETTE ROSE GLYNN (MPH)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:ROSE GLYNN
Last Name:GABA
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5759 S ASHFORD WAY
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-7489
Mailing Address - Country:US
Mailing Address - Phone:419-251-8086
Mailing Address - Fax:419-251-7719
Practice Address - Street 1:3000 ARLINGTON AVE # MS 1195
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-6644
Practice Address - Fax:419-383-3372
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1450520104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker