Provider Demographics
NPI:1972273738
Name:DREYFUS, COLLEEN
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:DREYFUS
Suffix:
Gender:F
Credentials:
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 102
Mailing Address - Street 2:
Mailing Address - City:STEPHENSPORT
Mailing Address - State:KY
Mailing Address - Zip Code:40170-0102
Mailing Address - Country:US
Mailing Address - Phone:270-617-0929
Mailing Address - Fax:
Practice Address - Street 1:49 M EARLY LN.
Practice Address - Street 2:
Practice Address - City:STEPHENSPORT
Practice Address - State:KY
Practice Address - Zip Code:40170
Practice Address - Country:US
Practice Address - Phone:270-617-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator