Provider Demographics
NPI:1487005211
Name:COLBORN, ANDREA SUE (LLPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:COLBORN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18277 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:49403-9731
Mailing Address - Country:US
Mailing Address - Phone:616-263-9191
Mailing Address - Fax:
Practice Address - Street 1:18277 28TH AVE
Practice Address - Street 2:
Practice Address - City:CONKLIN
Practice Address - State:MI
Practice Address - Zip Code:49403-9731
Practice Address - Country:US
Practice Address - Phone:616-263-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other