Provider Demographics
NPI:1811231996
Name:COLBERG, KARR1 (MST, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARR1
Middle Name:
Last Name:COLBERG
Suffix:
Gender:F
Credentials:MST, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S 3RD ST
Mailing Address - Street 2:WEB B30
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-5010
Mailing Address - Country:US
Mailing Address - Phone:715-425-0674
Mailing Address - Fax:
Practice Address - Street 1:410 S 3RD ST
Practice Address - Street 2:WEB B30
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-5010
Practice Address - Country:US
Practice Address - Phone:715-425-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3710-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist