Healthcare Provider Details

I. General information

NPI: 1346280435
Provider Name (Legal Business Name): COLEEN R MAY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 9TH AVE S
FARGO ND
58103-2350
US

IV. Provider business mailing address

338 15TH ST S
MOORHEAD MN
56560-3036
US

V. Phone/Fax

Practice location:
  • Phone: 701-298-4500
  • Fax: 701-298-4400
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2753
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12248
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier16R44MA
Identifier TypeOTHER
Identifier StateFM
Identifier IssuerBLLUE SHIELD OF MINNESOTA
# 2
Identifier17786
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerNORTH DAKOTA BLUE SHIELD
# 3
Identifier108218300
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 4
Identifier1016218
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerPREFERREDONE
# 5
IdentifierHP27801
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerHEALTHPARTNERS
# 6
Identifier111699
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerUCARE MINNESOTA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: