Provider Demographics
NPI:1013033687
Name:VASQUES, COLLEEN (MS CCC-A)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:VASQUES
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PEARL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2866
Mailing Address - Country:US
Mailing Address - Phone:781-769-3222
Mailing Address - Fax:781-255-9807
Practice Address - Street 1:35 PEARL ST STE 100
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2866
Practice Address - Country:US
Practice Address - Phone:781-769-3222
Practice Address - Fax:781-255-9807
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA418231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD 0037OtherBLUE CROSS PROVIDER NBR.
MAAD 0037OtherBLUE CROSS PROVIDER NBR.