Provider Demographics
NPI:1407371503
Name:COLBY, ALICIA M (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:COLBY
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 1:812 E IVY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5107
Mailing Address - Country:US
Mailing Address - Phone:937-573-9574
Mailing Address - Fax:919-297-2993
Practice Address - Street 1:500 HOLLY SPRINGS RD STE 103
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-6204
Practice Address - Country:US
Practice Address - Phone:919-297-2997
Practice Address - Fax:919-297-2993
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12476235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist