Provider Demographics
NPI:1477796902
Name:WORTHINGTON, COLLEEN K (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:K
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT. OF HEARING & SPEECH SCIENCES 0100 LEFRAK HALL
Mailing Address - Street 2:UNIVERSITY OF MARYLAND
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20742
Mailing Address - Country:US
Mailing Address - Phone:301-405-4238
Mailing Address - Fax:301-314-2023
Practice Address - Street 1:DEPT. OF HEARING & SPEECH SCIENCES 0100 LEFRAK HALL
Practice Address - Street 2:UNIVERSITY OF MARYLAND
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20742
Practice Address - Country:US
Practice Address - Phone:301-405-4238
Practice Address - Fax:301-314-2023
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02036235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist