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General NPI Number Information
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NPI Number | 1528209590
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Entity Type | Individual
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Provider Name | IDA VERONICA COLQUITT LLP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 245 PITKIN ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3737
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Country | US
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Telephone | 313-865-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 20690 WAYLAND ST
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5666
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Country | US
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Telephone | 248-763-0801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704425366
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301013981
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License Number State | MI
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