Provider Demographics
NPI:1700031101
Name:GALLAGHER, COLLEEN PATRICIA (MS CCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:GALLAGHER
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 1:5 MIDDLESEX AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145
Mailing Address - Country:US
Mailing Address - Phone:717-979-0570
Mailing Address - Fax:
Practice Address - Street 1:100 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1314
Practice Address - Country:US
Practice Address - Phone:717-979-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008856235Z00000X
MA7386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist