Provider Demographics
NPI:1447989272
Name:COMBELLICK, COLTER (MSW, LICSW, CSW-PIP)
Entity type:Individual
Prefix:MR
First Name:COLTER
Middle Name:
Last Name:COMBELLICK
Suffix:
Gender:
Credentials:MSW, LICSW, CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 BROADWAY ST STE 240
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2664
Mailing Address - Country:US
Mailing Address - Phone:320-200-5028
Mailing Address - Fax:
Practice Address - Street 1:1210 BROADWAY ST STE 240
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2664
Practice Address - Country:US
Practice Address - Phone:320-200-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD51851041C0700X
MN260001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical