MEDICARE: COLONIAL INTERMEDIATE UNIT 20

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	235100	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497273791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL INTERMEDIATE UNIT 20

Provider Business Mailing Address
First Line	:	6 DANFORTH DR
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-7820
Country	:	US
Telephone Number	:	610-515-6439
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 WEST UNION BLVD
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18018-3509
Country	:	US
Telephone Number	:	610-515-6439
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. CHRISTOPHER WOLFEL
Credential	:	D. ED.
Telephone Number	:	610-252-5550

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	09/06/2022

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