Provider Demographics
NPI:1356784144
Name:COLBY, ALYSSA JOANN (IBCLC, CHW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JOANN
Last Name:COLBY
Suffix:
Gender:F
Credentials:IBCLC, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-2014
Mailing Address - Country:US
Mailing Address - Phone:541-280-3031
Mailing Address - Fax:
Practice Address - Street 1:375 NW BEAVER ST STE 100
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1802
Practice Address - Country:US
Practice Address - Phone:541-447-5165
Practice Address - Fax:541-447-3093
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10154656176B00000X
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDEM-LD-10154656OtherMIDWIFERY LICENSE NUMBER