Provider Demographics
NPI:1619443959
Name:KOLBERG, NATALIE J (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:J
Last Name:KOLBERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:J
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4141 LAVENDER CIR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-8718
Mailing Address - Country:US
Mailing Address - Phone:248-556-6675
Mailing Address - Fax:
Practice Address - Street 1:1451 BRONSON WAY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3306
Practice Address - Country:US
Practice Address - Phone:248-556-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI$$$$$$$$$Medicaid