Active NPI
Kathleen Phyllis Colley, MSW
- Clinical Social Worker
- Grand Forks, ND
National Provider Identifier
1124236443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 16080
- Practice address
- 1407 24TH Ave S Ste 217
Grand Forks, ND 58201-6761 - Phone
- (701) 738-0888
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 16080 | MN | Primary |
Addresses
Primary practice location
1407 24TH Ave S Ste 217
Grand Forks, ND 58201-6761
Mailing address
20531 US Highway 75 SW
Crookston, MN 56716-9045
Phone (218) 281-3351
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16080 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124236443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20531 US HIGHWAY 75 SW",
"city": "CROOKSTON",
"state": "MN",
"postal_code": "567169045",
"telephone_number": "218-281-3351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1407 24TH AVE S STE 217",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582016761",
"telephone_number": "701-738-0888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLEY",
"first_name": "KATHLEEN",
"middle_name": "PHYLLIS",
"credential": "MSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "16080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.