Organization
COLONIAL INTERMEDIATE UNIT #20
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEN KOSIBA (ASST MGMT TO MEDICAL BILLING)
(610) 515-6439
Entity
Organization
Contact information
Practice address
180 PANTHER LN, POCONO SUMMIT, PA 18346-7724
(610) 515-6439
(484) 291-4135
Mailing address
6 DANFORTH DR, EASTON, PA 18045-7820
(610) 252-5550
(610) 252-5740
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007544600
—
PA
Enumeration date
04/01/2025
Last updated
04/01/2025
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