Provider Demographics
NPI:1689952988
Name:BASLER, COLLEEN NICOLE (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:NICOLE
Last Name:BASLER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:NICOLE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4200 N CLOVERLEAF DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6436
Mailing Address - Country:US
Mailing Address - Phone:636-441-7470
Mailing Address - Fax:636-441-4270
Practice Address - Street 1:4200 N CLOVERLEAF DR STE B
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6436
Practice Address - Country:US
Practice Address - Phone:636-441-7470
Practice Address - Fax:636-441-4270
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011024856237700000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist