| Shannon Colburn-blinn, Lcsw | |
|
2200 Lake Ave Ste 140 Fort Wayne IN 46805-5351 | |
| (260) 702-9036 | |
| Not Available |
| Full Name | Shannon Colburn-blinn, Lcsw |
|---|---|
| Speciality | Counselor |
| Location | 2200 Lake Ave Ste 140, Fort Wayne, Indiana |
| Authorized Official Name and Position | Shannon R Colburn-blinn (OWNER) |
| Authorized Official Contact | 2607029036 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon Colburn-blinn, Lcsw 2200 Lake Ave Ste 140 Fort Wayne IN 46805-5351 Ph: (260) 702-9036 | Shannon Colburn-blinn, Lcsw 2200 Lake Ave Ste 140 Fort Wayne IN 46805-5351 Ph: (260) 702-9036 |
| NPI Number | 1811467632 |
|---|---|
| Provider Enumeration Date | 12/05/2018 |
| Last Update Date | 02/08/2019 |
| Medicare PECOS PAC ID | 3971843186 |
|---|---|
| Medicare Enrollment ID | O20190326002675 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811467632 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shannon Rae Colburn-blinn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053766782 PECOS PAC ID: 4880934090 Enrollment ID: I20190326002742 |
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