Provider Demographics
NPI:1922241991
Name:EGBUNA, COLLEEN KUGEL (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:KUGEL
Last Name:EGBUNA
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 1:352A CHRISTOPHER AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3660
Mailing Address - Country:US
Mailing Address - Phone:301-977-6400
Mailing Address - Fax:301-977-6401
Practice Address - Street 1:352A CHRISTOPHER AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3660
Practice Address - Country:US
Practice Address - Phone:301-977-6400
Practice Address - Fax:301-977-6401
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06727235Z00000X
DCSLP000791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist