Provider Demographics
NPI:1316225980
Name:REPETTO, COLLEEN MARIE
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:REPETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4400 VESTAL PARKWAY EAST
Mailing Address - Street 2:INSTITUTE FOR CHILD DEVELOPMENT BINGHAMTON UNIVERSITY
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13902-6000
Mailing Address - Country:US
Mailing Address - Phone:607-777-2829
Mailing Address - Fax:
Practice Address - Street 1:4400 VESTAL PARKWAY EAST
Practice Address - Street 2:INSTITUTE FOR CHILD DEVELOPMENT BINGHAMTON UNIVERSITY
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13902-6000
Practice Address - Country:US
Practice Address - Phone:607-777-2829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020818-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist