Provider Demographics
NPI:1053778373
Name:COLBORN, JEANNA CHAY (MA, SE)
Entity type:Individual
Prefix:MRS
First Name:JEANNA
Middle Name:CHAY
Last Name:COLBORN
Suffix:
Gender:F
Credentials:MA, SE
Other - Prefix:MS
Other - First Name:JEANNA
Other - Middle Name:CHAY
Other - Last Name:LANGENWALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, SE
Mailing Address - Street 1:SANCTUARY 4737 AFTON PL
Mailing Address - Street 2:STE #A
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202
Mailing Address - Country:US
Mailing Address - Phone:208-417-0623
Mailing Address - Fax:208-417-0641
Practice Address - Street 1:SANCTUARY 4737 AFTON PL
Practice Address - Street 2:STE #A
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202
Practice Address - Country:US
Practice Address - Phone:208-417-0623
Practice Address - Fax:208-417-0641
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSE - 202928103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist