Provider Demographics
NPI:1720741598
Name:KOLLEGGER, NOAH
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:KOLLEGGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12838 SE 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1212
Mailing Address - Country:US
Mailing Address - Phone:208-419-9535
Mailing Address - Fax:
Practice Address - Street 1:12838 SE 40TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1212
Practice Address - Country:US
Practice Address - Phone:208-419-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor