Provider Demographics
NPI:1144794033
Name:GORECKI, COLLEEN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GORECKI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HARBOR OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-2819
Mailing Address - Country:US
Mailing Address - Phone:734-252-9277
Mailing Address - Fax:
Practice Address - Street 1:910 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6600
Practice Address - Country:US
Practice Address - Phone:734-516-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty