Provider Demographics
NPI:1114171139
Name:SKUFCA, COLLEEN E (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:E
Last Name:SKUFCA
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12997
Mailing Address - Country:US
Mailing Address - Phone:518-946-2380
Mailing Address - Fax:
Practice Address - Street 1:42 INDIAN ROCK ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NY
Practice Address - Zip Code:12997
Practice Address - Country:US
Practice Address - Phone:518-946-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00603701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00603701Medicaid