Provider Demographics
NPI:1801222179
Name:CASEY, COLLEEN M (MT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:CASEY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 W 23RD AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4822
Mailing Address - Country:US
Mailing Address - Phone:206-719-1366
Mailing Address - Fax:
Practice Address - Street 1:800 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2710
Practice Address - Country:US
Practice Address - Phone:206-719-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0013160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist