Provider Demographics
NPI:1194596577
Name:COLPEAN, ROBERT LESTER III
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LESTER
Last Name:COLPEAN
Suffix:III
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 1:5933 SE HAIG ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2723
Mailing Address - Country:US
Mailing Address - Phone:971-275-6257
Mailing Address - Fax:
Practice Address - Street 1:5933 SE HAIG ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2723
Practice Address - Country:US
Practice Address - Phone:971-275-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA147031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical