Provider Demographics
NPI:1760653190
Name:RITARI, COLEEN SUE (MA CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:SUE
Last Name:RITARI
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:MRS
Other - First Name:COLEEN
Other - Middle Name:SUE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCSLP
Mailing Address - Street 1:6508 GUNN HIGHWAY
Mailing Address - Street 2:INDEPENDENT LIVING INC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4022
Mailing Address - Country:US
Mailing Address - Phone:813-963-6923
Mailing Address - Fax:813-264-0768
Practice Address - Street 1:6508 GUNN HIGHWAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4022
Practice Address - Country:US
Practice Address - Phone:813-963-6923
Practice Address - Fax:813-264-0768
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist