Provider Demographics
NPI:1477851301
Name:COLON, LIZZA I (SLP, TSHH)
Entity Type:Individual
Prefix:
First Name:LIZZA
Middle Name:I
Last Name:COLON
Suffix:
Gender:F
Credentials:SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 134TH ST
Mailing Address - Street 2:APT. 6E
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1400
Mailing Address - Country:US
Mailing Address - Phone:917-804-4690
Mailing Address - Fax:
Practice Address - Street 1:8235 134TH ST
Practice Address - Street 2:APT. 6E
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1400
Practice Address - Country:US
Practice Address - Phone:917-804-4690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021498235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist