Provider Demographics
NPI:1457668980
Name:COLL, MICHELLE BROZO (MS,CCC/A)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:BROZO
Last Name:COLL
Suffix:
Gender:F
Credentials:MS,CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7335 WALLA WALLA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5242
Mailing Address - Country:US
Mailing Address - Phone:210-382-2961
Mailing Address - Fax:
Practice Address - Street 1:7335 WALLA WALLA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5242
Practice Address - Country:US
Practice Address - Phone:210-382-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51293231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist