Provider Demographics
NPI:1538616594
Name:ROBERTSON COLLINWOOD, SHANLEE (CPM)
Entity type:Individual
Prefix:
First Name:SHANLEE
Middle Name:
Last Name:ROBERTSON COLLINWOOD
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 E 2700 S APT 60
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2647
Mailing Address - Country:US
Mailing Address - Phone:470-588-6464
Mailing Address - Fax:801-477-8451
Practice Address - Street 1:1148 E 2700 S APT H60
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84106-2647
Practice Address - Country:US
Practice Address - Phone:470-588-6464
Practice Address - Fax:801-477-8451
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 174N00000X, 374J00000X
AZLM218176B00000X
UT10513702-3400176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula