Provider Demographics
NPI:1508417122
Name:COLTON, SHYANN ALEXIS
Entity Type:Individual
Prefix:
First Name:SHYANN
Middle Name:ALEXIS
Last Name:COLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 APPIAN WAY APT E202
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4393
Mailing Address - Country:US
Mailing Address - Phone:586-244-7588
Mailing Address - Fax:
Practice Address - Street 1:2520 UNIVERSITY PARK BLDG D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4464
Practice Address - Country:US
Practice Address - Phone:989-774-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician