Provider Demographics
NPI:1790218378
Name:COLLAZO, WALESKA (THL)
Entity Type:Individual
Prefix:
First Name:WALESKA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CALLE 3S 30
Mailing Address - Street 2:ALTURAS DE BUCARABONES
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4711
Mailing Address - Country:US
Mailing Address - Phone:787-203-5232
Mailing Address - Fax:
Practice Address - Street 1:44 CALLE 3 # 30
Practice Address - Street 2:ALTURAS DE BUCARABONES
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2459
Practice Address - Country:US
Practice Address - Phone:787-203-5232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant