Provider Demographics
NPI:1588784854
Name:PRITCHARD, COLLEEN MARIE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GALEN DR
Mailing Address - Street 2:4L, BLDG W, #13
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-7038
Mailing Address - Country:US
Mailing Address - Phone:217-351-2611
Mailing Address - Fax:217-351-2612
Practice Address - Street 1:2500 GALEN DR
Practice Address - Street 2:4L, BLDG W, #13
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-7038
Practice Address - Country:US
Practice Address - Phone:217-351-2611
Practice Address - Fax:217-351-2612
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149 0105731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical