Healthcare Provider Details

I. General information

NPI: 1922923390
Provider Name (Legal Business Name): SENIA FAYE KOLPACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 QUINCY ST
HANCOCK MI
49930-1817
US

IV. Provider business mailing address

35723 US HIGHWAY 45
ONTONAGON MI
49953-9300
US

V. Phone/Fax

Practice location:
  • Phone: 906-482-4880
  • Fax:
Mailing address:
  • Phone: 906-390-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25499282
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: