Provider Demographics
NPI:1306466461
Name:COLTON, CATHERINE ANN (MED)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:ANN
Last Name:COLTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2948 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4776
Mailing Address - Country:US
Mailing Address - Phone:208-305-7221
Mailing Address - Fax:
Practice Address - Street 1:2948 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4776
Practice Address - Country:US
Practice Address - Phone:208-305-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician