Provider Demographics
NPI:1861532798
Name:RINKEN, COLLEEN MARIE (MED)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:RINKEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4705
Mailing Address - Country:US
Mailing Address - Phone:715-842-3346
Mailing Address - Fax:715-842-3344
Practice Address - Street 1:903 2ND ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4705
Practice Address - Country:US
Practice Address - Phone:715-842-3346
Practice Address - Fax:715-842-3344
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1749101YA0400X
WI2755125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39371300Medicaid