Provider Demographics
NPI:1417224213
Name:HAVRANEK, COLLEEN A (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:A
Last Name:HAVRANEK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 EAGLES ROOST LN
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8888
Mailing Address - Country:US
Mailing Address - Phone:315-524-1170
Mailing Address - Fax:315-524-1049
Practice Address - Street 1:3290 EAGLES ROOST LANE
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8888
Practice Address - Country:US
Practice Address - Phone:315-524-1170
Practice Address - Fax:315-524-1049
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009534-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist