Provider Demographics
NPI:1639429764
Name:LAMA, COLLEEN MARIAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:MARIAH
Last Name:LAMA
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 1:13908 SEAFORTH MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1925
Mailing Address - Country:US
Mailing Address - Phone:219-241-3235
Mailing Address - Fax:
Practice Address - Street 1:3333 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2100
Practice Address - Country:US
Practice Address - Phone:813-269-4879
Practice Address - Fax:813-433-5561
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-20949103K00000X
FLSA12561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007181700Medicaid