Provider Demographics
NPI:1043891815
Name:COLICCHIO, MAGGIE ANNE
Entity Type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:ANNE
Last Name:COLICCHIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1182
Mailing Address - Country:US
Mailing Address - Phone:540-484-1456
Mailing Address - Fax:
Practice Address - Street 1:300 PELL AVE STE B
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1182
Practice Address - Country:US
Practice Address - Phone:540-484-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist