Provider Demographics
NPI:1124170501
Name:COLON, SUSAN M (MSED, BA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:COLON
Suffix:
Gender:M
Credentials:MSED, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1820
Mailing Address - Country:US
Mailing Address - Phone:570-524-7708
Mailing Address - Fax:
Practice Address - Street 1:10 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1820
Practice Address - Country:US
Practice Address - Phone:570-524-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator