Provider Demographics
NPI:1689177693
Name:CLEARY, COLLEEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:CLEARY
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 1:2021 YGNACIO VALLEY RD STE C202
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3392
Mailing Address - Country:US
Mailing Address - Phone:925-945-1474
Mailing Address - Fax:
Practice Address - Street 1:2021 YGNACIO VALLEY RD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3391
Practice Address - Country:US
Practice Address - Phone:925-822-7776
Practice Address - Fax:925-822-7776
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24429235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist