Provider Demographics
NPI:1841172095
Name:COLASURDO, ISABELLA ROSE
Entity type:Individual
Prefix:MISS
First Name:ISABELLA
Middle Name:ROSE
Last Name:COLASURDO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BELLA
Other - Middle Name:ROSE
Other - Last Name:COLASURDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:123 BREMERTON AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5236
Mailing Address - Country:US
Mailing Address - Phone:206-271-4487
Mailing Address - Fax:
Practice Address - Street 1:22415 SE 231ST ST STE B103
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5002
Practice Address - Country:US
Practice Address - Phone:425-906-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician