Provider Demographics
NPI:1679335319
Name:WRIGHT, COLTON
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 SCHAUMBURG LN
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-9220
Mailing Address - Country:US
Mailing Address - Phone:815-713-7779
Mailing Address - Fax:
Practice Address - Street 1:6065 SCHAUMBURG LN
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-9220
Practice Address - Country:US
Practice Address - Phone:815-713-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program