=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205725405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNA CAROLE COLEGROVE MSW, SSW-PPSC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2025
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38016 STATE HWY 96
-----------------------------------------------------
City | ORLEANS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95556-0130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-625-5600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1308
-----------------------------------------------------
City | HOOPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95546-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-625-5600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------