Provider Demographics
NPI:1598378382
Name:BEMIS, COLLEEN JOYCE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JOYCE
Last Name:BEMIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3141
Mailing Address - Country:US
Mailing Address - Phone:860-985-3274
Mailing Address - Fax:
Practice Address - Street 1:101 PARK ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3141
Practice Address - Country:US
Practice Address - Phone:860-985-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist