Provider Demographics
NPI:1386189835
Name:SMITH, COLLEEN PATRICIA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478-2913
Mailing Address - Country:US
Mailing Address - Phone:315-829-2529
Mailing Address - Fax:315-829-5966
Practice Address - Street 1:5275 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478
Practice Address - Country:US
Practice Address - Phone:315-829-2529
Practice Address - Fax:315-829-5966
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist