Provider Demographics
NPI:1134428667
Name:SOLBERG, COLLEEN ELAINE
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELAINE
Last Name:SOLBERG
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 1:610 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4704
Mailing Address - Country:US
Mailing Address - Phone:507-451-2630
Mailing Address - Fax:507-455-8133
Practice Address - Street 1:134 E VINE ST STE 202
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2428
Practice Address - Country:US
Practice Address - Phone:507-455-1302
Practice Address - Fax:507-455-1264
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN155951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical