Provider Demographics
NPI:1437970811
Name:WILEY, COLLEEN RENEE (RBT 24-343610)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:RENEE
Last Name:WILEY
Suffix:
Gender:F
Credentials:RBT 24-343610
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 S KIHEI RD
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5802
Mailing Address - Country:US
Mailing Address - Phone:252-343-8261
Mailing Address - Fax:
Practice Address - Street 1:1367 S KIHEI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5802
Practice Address - Country:US
Practice Address - Phone:252-343-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician