Individual
JACOB COLBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3552 LONE PINE RD, MEDFORD, OR 97504-5637
(541) 727-1592
Mailing address
99 N FRONT ST, TALENT, OR 97540-6688
(530) 515-2017
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83-1354508
—
OR
Enumeration date
10/07/2021
Last updated
10/07/2021
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