Provider Demographics
NPI:1558654624
Name:LANTELME, COLETTE KIM (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:KIM
Last Name:LANTELME
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 SUMMER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-7561
Mailing Address - Country:US
Mailing Address - Phone:919-500-3770
Mailing Address - Fax:
Practice Address - Street 1:6224 ALFALFA LN
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6451
Practice Address - Country:US
Practice Address - Phone:919-500-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist