Provider Demographics
NPI:1164097184
Name:COLLIGO SPEECH LANGUAGE PATHOLOGY, PA
Entity Type:Organization
Organization Name:COLLIGO SPEECH LANGUAGE PATHOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN-AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-283-4800
Mailing Address - Street 1:8830 S LAKE DASHA DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3011
Mailing Address - Country:US
Mailing Address - Phone:305-283-4800
Mailing Address - Fax:
Practice Address - Street 1:8830 S LAKE DASHA DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3011
Practice Address - Country:US
Practice Address - Phone:305-283-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111133300Medicaid
FL111133600Medicaid