Provider Demographics
NPI:1740698752
Name:TILLGER, COLLEEN
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:TILLGER
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 1:1125 BEN FRANKLIN HWY W
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1829
Mailing Address - Country:US
Mailing Address - Phone:610-385-3155
Mailing Address - Fax:
Practice Address - Street 1:1125 BEN FRANKLIN HWY W
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1829
Practice Address - Country:US
Practice Address - Phone:610-385-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007617101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)