Healthcare Provider Details

I. General information

NPI: 1184684276
Provider Name (Legal Business Name): MICHELLE WALTON COLBURN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANGELA MICHELLE WALTON

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 FARMINGTON AVE
WEST HARTFORD CT
06107-2181
US

IV. Provider business mailing address

1013 FARMINGTON AVE
WEST HARTFORD CT
06107-2181
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-2020
  • Fax:
Mailing address:
  • Phone: 860-233-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000509
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: