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General NPI Number Information
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NPI Number | 1730088162
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Entity Type | Individual
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Provider Name | COLLEEN EDGERTON
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Gender | Female
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 8051 PINE KNOB RD
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City | CLARKSTON
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State | MI
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Zip | 48348-3767
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Country | US
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Telephone | 248-623-5339
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Fax |
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Provider Business Mailing Address
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Address Line | 5629 PERRYTOWN DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1506
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Country | US
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Telephone | 248-672-0619
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 6801094351
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License Number State | MI
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