| Doctor Name: | COLLEEN ADA BANNISTER |
| NPI Number: | 1114304672 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 491 Main St Athol, MA - 013311846 |
| Business Phone Number: | 9782499490 |
| Business Fax Number: | |
| Mailing Address: | 491 Main St, ATHOL |
| State: | MA |
| Postal Code: | 013311846 |
| Phone Number: | 9782499490 |
| Fax Number: | |
| NPI Enumeration Date: | 05/04/2015 |
| NPI Last Update Date: | 05/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |