Provider Demographics
NPI:1730414343
Name:COLBERT, MICHAEL SCOTT
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:COLBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:SCOTT
Other - Last Name:COLBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8123
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:1551 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2226
Practice Address - Country:US
Practice Address - Phone:805-474-8154
Practice Address - Fax:805-474-8156
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5026237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist