Provider Demographics
NPI:1205181872
Name:MCCOLGAN, KERRY ELLEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ELLEN
Last Name:MCCOLGAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:340 TURNPIKE ST
Mailing Address - Street 2:SUITE 1-3A
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2700
Mailing Address - Country:US
Mailing Address - Phone:781-619-1500
Mailing Address - Fax:781-619-1509
Practice Address - Street 1:340 TURNPIKE ST
Practice Address - Street 2:SUITE 1-3A
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2700
Practice Address - Country:US
Practice Address - Phone:781-619-1500
Practice Address - Fax:781-619-1509
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-8642-SL235Z00000X
MD06942235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist