Provider Demographics
NPI:1689121287
Name:ENRIGHT, COLETTE
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:ENRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:TIMBER LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57656-0231
Mailing Address - Country:US
Mailing Address - Phone:605-466-2206
Mailing Address - Fax:605-466-2207
Practice Address - Street 1:503 N MAIN
Practice Address - Street 2:
Practice Address - City:ISABEL
Practice Address - State:SD
Practice Address - Zip Code:57633-0035
Practice Address - Country:US
Practice Address - Phone:605-466-2206
Practice Address - Fax:605-466-2207
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD090-LIMITED235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist