Provider Demographics
NPI:1902041841
Name:CASE, COLLETTE MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:MARIE
Last Name:CASE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:COLLETTE
Other - Middle Name:MARIE
Other - Last Name:DIEBOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4 SETTLER AVE
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2118
Mailing Address - Country:US
Mailing Address - Phone:631-312-2599
Mailing Address - Fax:631-828-1035
Practice Address - Street 1:4 SETTLER AVE
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2118
Practice Address - Country:US
Practice Address - Phone:631-312-2599
Practice Address - Fax:631-828-1035
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist