Healthcare Provider Details

I. General information

NPI: 1518169374
Provider Name (Legal Business Name): COLETTE M MICHAELSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 N SUN VALLEY DR
PALMER AK
99645-9254
US

IV. Provider business mailing address

9200 N SUN VALLEY DR
PALMER AK
99645-9254
US

V. Phone/Fax

Practice location:
  • Phone: 907-745-4295
  • Fax:
Mailing address:
  • Phone: 907-745-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: