Provider Demographics
NPI:1942021423
Name:COLE, KAE'VIONNA
Entity type:Individual
Prefix:
First Name:KAE'VIONNA
Middle Name:
Last Name:COLE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 CRITERION DR UNIT 62092
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-1014
Mailing Address - Country:US
Mailing Address - Phone:719-204-6223
Mailing Address - Fax:
Practice Address - Street 1:8585 CRITERION DR UNIT 62092
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80962-1014
Practice Address - Country:US
Practice Address - Phone:719-204-6223
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 Licenses
StateLicense IDTaxonomies
COSWC.00000008801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical