Provider Demographics
NPI:1679020838
Name:KOLB, CALLIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:KOLB
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 HAWTHORNE AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4675
Mailing Address - Country:US
Mailing Address - Phone:503-926-4299
Mailing Address - Fax:503-926-9322
Practice Address - Street 1:748 HAWTHORNE AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4675
Practice Address - Country:US
Practice Address - Phone:503-926-4299
Practice Address - Fax:503-926-9322
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist