Provider Demographics
NPI:1881374643
Name:JANSEN, COLBY MARIE
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:MARIE
Last Name:JANSEN
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 1:6444 FAIRWAY AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-3073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:780 COMMERCIAL ST SE STE 104
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3465
Practice Address - Country:US
Practice Address - Phone:971-901-2731
Practice Address - Fax:971-901-3065
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health