Physician Compare National (NPI:1790069672)

HEALTHCARE PROVIDER: DESIREE ANN COLONICA LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1790069672
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274892567
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180111002957
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COLONICA
	Individual professional last name
Provider First Name	DESIREE
	Individual professional first name
Provider Middle Name	ANN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2396 NW KINGS BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	CORVALLIS
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	973303984
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y