Healthcare Provider Details

I. General information

NPI: 1033200613
Provider Name (Legal Business Name): JEAN LOUISE KOLBE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAPLE DR STE A
WEXFORD PA
15090-8327
US

IV. Provider business mailing address

201 PETERS DR
GLENSHAW PA
15116-1225
US

V. Phone/Fax

Practice location:
  • Phone: 412-874-2665
  • Fax:
Mailing address:
  • Phone: 412-486-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013136
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier474451
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BC/BS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: