Provider Demographics
NPI:1194422394
Name:COLON, KATHERINE NICOLE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:NICOLE
Last Name:COLON
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 1:308 GLENN IVY TER
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-9447
Mailing Address - Country:US
Mailing Address - Phone:352-515-8505
Mailing Address - Fax:
Practice Address - Street 1:308 GLENN IVY TER
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-9447
Practice Address - Country:US
Practice Address - Phone:352-515-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst