Provider Demographics
NPI:1689090821
Name:WALIZER, COLLEEN (MS, BA)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:WALIZER
Suffix:
Gender:F
Credentials:MS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 NW PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4916
Mailing Address - Country:US
Mailing Address - Phone:772-475-0115
Mailing Address - Fax:
Practice Address - Street 1:10850 S FEDERAL HWY # 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6407
Practice Address - Country:US
Practice Address - Phone:772-475-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst