Provider Demographics
NPI:1710747894
Name:COLBY, SHAWN A (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:A
Last Name:COLBY
Suffix:
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23033
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-0033
Mailing Address - Country:US
Mailing Address - Phone:206-707-2344
Mailing Address - Fax:
Practice Address - Street 1:310 N MERIDIAN STE 209
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8644
Practice Address - Country:US
Practice Address - Phone:253-339-6094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61537717106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician