Provider Demographics
NPI:1184758153
Name:KOLLN, COREY ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ELIZABETH
Last Name:KOLLN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SUNDANCE DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8625
Mailing Address - Country:US
Mailing Address - Phone:502-849-8446
Mailing Address - Fax:
Practice Address - Street 1:451 SUNDANCE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8625
Practice Address - Country:US
Practice Address - Phone:502-849-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11365171W00000X
WA60955540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA225700000XOtherWASHINGTON STATE DEPT OF HEALTH
WA60955540OtherWASHINGTON STATE DEPT OF HEALTH