Provider Demographics
NPI:1639210156
Name:MYERS, COLETTE ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PITTSFORD PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5705
Mailing Address - Country:US
Mailing Address - Phone:919-489-3471
Mailing Address - Fax:919-489-3471
Practice Address - Street 1:7 PITTSFORD PL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5705
Practice Address - Country:US
Practice Address - Phone:919-489-3471
Practice Address - Fax:919-489-3471
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210506Medicaid
NC7411399Medicaid