Individual
COLETTE RANDOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
750 BROADWAY STE 350, FORT WAYNE, IN 46802-1412
(260) 423-2675
(260) 423-6621
Mailing address
750 BROADWAY STE 350, FORT WAYNE, IN 46802-1412
(260) 423-2675
(260) 423-6621
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
99109008A
IN
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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