Provider Demographics
NPI:1891468534
Name:MASSIMINI, COLINDA DIANE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:COLINDA
Middle Name:DIANE
Last Name:MASSIMINI
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 1:19317 N 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9504
Mailing Address - Country:US
Mailing Address - Phone:985-893-4323
Mailing Address - Fax:985-893-2123
Practice Address - Street 1:19317 N 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9504
Practice Address - Country:US
Practice Address - Phone:985-893-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist