Healthcare Provider Details

I. General information

NPI: 1508295361
Provider Name (Legal Business Name): COLLEEN QUICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILLOW PASS RD STE 100
CONCORD CA
94520-7946
US

IV. Provider business mailing address

1430 WILLOW PASS RD STE 100
CONCORD CA
94520-7946
US

V. Phone/Fax

Practice location:
  • Phone: 925-288-3900
  • Fax: 925-646-5774
Mailing address:
  • Phone: 925-288-3900
  • Fax: 925-646-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberMPSS-Y6OS2G
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-YGOS2G
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: